Role still exists for cycler therapy in anuric patients with a low-transport membrane.

It is generally believed that, to achieve adequacy targets, anuric patients with a low-transport membrane should be treated by continuous ambulatory peritoneal dialysis (CAPD) or CAPD with a night-exchange device. If adequacy targets are not reached, it is suggested that patients should be changed to hemodialysis. We would like to show that a role still exists for cycler + therapy (cycler therapy with a wet day or with only one manual exchange) in these patients, both for obtaining target Kt/V and for lifestyle. Using the PD Adequest computer program (Baxter Healthcare Corporation, Deerfield, IL, U.S.A.), we compared a night-exchange device [3 exchanges during the day and 2 exchanges during the night (3 + 2)] to various regimes of cycler + therapy. In all cases, the night-exchange volume exceeded the day-exchange volume by 500 mL. Using cycler + therapy in anuric patients with a low-transport membrane, with 6-7 exchanges over 9 hours, Kt/V can be increased by 10%-25%. A role therefore still exists for cycler + therapy in anuric patients with a low-transport membrane for lifestyle or to achieve a better Kt/V. Unfortunately, we saw no significant improvement in creatinine clearance.