CAPD with a night-exchange device is the only true CAPD?

In the treatment of uremia with continuous ambulatory peritoneal dialysis (CAPD), the long-night dwell has always been a problem because of fluid retention. The purposes of the study were, firstly, to compare the solute clearance between five exchanges a day using standard CAPD, with a long-night dwell, to the clearance obtained with five exchanges a day using CAPD with the night-exchange device (NXD), in which case a more even distribution of the exchanges over 24 hours is obtained. A second aim of the study was to identify the best obtainable solute clearance: CAPD with the night-exchange device, or a cycler with a wet day. In the past year and a half, we have optimized solute clearance, using the PD Adequest program in 60 patients. The five-exchanges-a-day CAPD with the night-exchange device always gives a better solute clearance than standard CAPD with five exchanges a day and the long-night dwell. Solute clearance was always better with CAPD with NXD, except for Kt/V in patients with high membrane transport, compared to cycler therapy with a wet day. High-dose cycler therapy with a wet day plus a midday exchange always gives a better solute clearance than CAPD with NXD.