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HomeHealthcare ProfessionalsHome therapiesPeritoneal dialysisAPD


APD


AUTOMATED PERITONEAL DIALYSIS WITH SLEEP•SAFE HARMONY AND SILENCIA




DISCLAIMER

Not all products and services are cleared or available for sale in all EU
countries. Check your country web site for details. 


WHY AUTOMATED PERITONEAL DIALYSIS (APD)?

APD uses a programmable machine, or cycler, that controls the volume, filling,
dwell time and drainage of the solution. Thanks to automated dialysis, patients
can be dialyzed at home, even when sleeping.

As APD is offering more free daytime, it is the PD technique with obvious
advantages for patient’s lifestyle. Patients may pursue a job and have more time
for personal and family activities.1

Finally, APD cyclers offer a variety of individualization options for the
treatment, allowing you to even better consider the needs of your patient,
supporting you to improve patient care.


IN APD BOTH OUR CYCLERS, SLEEP•SAFE HARMONY AND SILENCIA, OFFER ADVANCED
FEATURES, ALL AIMED AT IMPROVING PATIENT CARE.

 * Increased treatment flexibility with FlexPoint technology3
 * Integrated on-screen animations give guidance and facilitate setup3
 * As proposed by Fischbach et al., potentially improved ultrafiltration and
   clearance with individually adapted APD (aAPD)2


GETTING STARTED WITH EDUCATION IN APD – THE DIFFICULT PART WAS MAKING IT EASIER

FMC created training solutions that focus on conveying the information that
really matter and offers support in preparing and setting up the treatment.

2

PREPARATION

TRAIN

 * Spot-on training videos for caregivers and patients to support training
 * Start with supportive extra training material for our APD devices
 * Set of patient information materials to support you in training the patient

START

 * Support in planning and preparing the therapeutic home environment

left
right


OUR PRODUCTS - KEY FEATURES OF THE SLEEP·SAFE HARMONY

sleep·safe harmony offers features aimed at improving patient care. It also
provides training support by guiding on-screen animations directly on the
device.


Guided prescriptions
 * Create prescriptions directly on the device
 * On-screen keyboard
 * Improved fluid usage – no extra volume for priming

FlexPoint intelligence combines settings such as:
 * Permitted patient volume – the maximum individual fill volume
 * Permitted residual volume – the maximum individual volume that may remain in
   the patient’s peritoneal cavity
    
 * The goal is to:
   * Reduce potential outflow alarms for a more quiet and restful sleep
   * Maintain the prescribed treatment time
   * Improve treatment effectiveness
   * Provide more flexibility in treatment execution within defined individual
     limits to improve patients’ well-being and safety

Convenient handling
 * Automatic connection and barcode recognition of bags
 * Integrated handles
 * PatientCardplus capable of storing up to nine different prescriptions and
   more than 12 months of treatment data
 * Automatic inline flow heating of the dialysis solution to body temperature
   directly during the inflow phase -  no need to preheat the solution bag
   upfront/in advance of the treatment
 * Automatic draining feature – the solution bags and the line set are drained
   automatically, no manual handling needed

Simple installation
 * Plug & use – no transformer needed due to double installation

Training support
 * Guiding animations directly on the device
 * Large touch screen

Environmentally friendly
 * sleep•safe harmony system daily disposables are made of PVC-free and
   plasticizer-free materials such as Biofine (Except APD drainage options)




OUR PRODUCTS - KEY FEATURES OF SILENCIA

SILENCIA is delivering individual APD therapy in a reliable and convenient way,
providing the following benefits :

 * Improved sleep quality due to silent operation and soft alarms4,5
 * Simple design enables easy setup and short training time6
 * APD individualization as supported by the latest ISPD guidelines7
 * Developed for home use even with limited space
 * High patient satisfaction with the handling of the SILENCIA cycler
 * Increased treatment flexibility with FlexPoint technology3 


ADAPTED APD (AAPD) IS ONE WAY TO PERSONALIZE TREATMENTS

sleep•safe harmony and SILENCIA offer multiple options to individualize
prescriptions according to patients' needs. Using our APD cyclers, the
prescription can be individualized on several levels:

 * Infusion volume
 * Dwell time
 * Glucose profile
 * Calcium profile
 * FlexPoint


Different PD solutions per cycle within the same treatment can be used with
sleep•safe harmony.


BECAUSE EVERY PATIENT IS DIFFERENT: AAPD – FISCHBACH ET AL.2 SUGGESTS POTENTIAL
BETTER RESULTS USING THE SAME TIME AND RESOURCES2

Your patients have a chronic disease in common, but differ in many ways: age,
height, weight, stage of illness, residual kidney function etc. These
differences have a decision impact on the PD treatment required. 
Patients’ needs are different:

Age

Age is an important factor influencing the choice of dialysis modality. Patients
with good dexterity and motivation are good candidates for PD. With increasing
age, the associated comorbidities of dialysis patients might deteriorate and
with it their frailty.

Weight

Management of weight is an important success factor in PD patients. Changes in
weight due to lifestyle, calorie intake, disease and hydration status need
constant monitoring and adaptation of PD therapy.

D/P creatinine

Dialysate to plasma ratio is a common measure used to evaluate peritoneal
transport characteristic in PD patients. Patients can be into high (fast), high
average and low (slow) transporters based depending upon the status of their
peritoneal membrane.  Peritoneal membrane transport characteristics change with
time on PD. Therefore, regular monitoring of D/P creatinine and subsequent
adjustment of PD prescriptions is recommended.

Transporter type

Patients are classified into high (fast), high average and low (slow)
transporters based on the function of their peritoneal membrane. With time and
increasing duration of stay on PD, patients tend to become fast transporters. PD
prescriptions need to be adapted according to patients' transport status for an
optimal patient outcome.

Residual kidney function (RKF)

RKF has an impact on patient survival and quality of life of PD dialysis
patients. Its longer preservation is a major advantage. Thus, interventions to
preserve RKF, like prescription of biocompatible PD fluids, are important.

Ultrafiltration

Due to compromised kidney function, bodies' own capacity to remove excess fluid
also diminishes and patients need dialysis to generate UF. The amount of UF
needed varies depending upon many factors, like lifestyle, disease progression
and other comorbid conditions. An adequate UF is therefore critical for
successful PD.

Kt/V urea

Kt/V urea is urea clearance normalized to total body water. It is an important
parameter to check PD adequacy. A total Kt/V urea of at least 1.7 per week is
recommended for PD patients.8




FISCHBACH STUDY SUPPORTS AAPD2

Fischbach M. et al. conducted a randomized, prospective, cross-over, multicenter
study. Nineteen patients were included in the final analysis.

According to Fischbach et al., aAPD offers better results using the same time
and resources2

 * aAPD is possible without extra fluids or a longer amount of time
 * Efficiently uses existing treatment resources: better ultrafiltration and
   clearance with same, low glucose concentration, fluid volume and treatment
   time compared to conventional APD (cAPD)


ATTAINING ADEQUACY TARGETS

The aAPD approach was proposed by Fischbach M. et al.2 By combining sequences of
short dwells and small fill volumes with long dwells and large fill volumes,
aAPD aims to promote UF and clearance within one PD session. The blood
purification and UF achieved for every gram of glucose absorbed was higher in
aAPD in comparison to cAPD.


THE CHALLENGES OF PD – REACHING ADEQUACY TARGETS

Reaching adequacy targets in PD for both UF and clearance is challenging.
Fischbach et al. propose that shorter dwell times and smaller fill volumes
promote the process of UF, while longer dwell times and large fill volumes
increase solute clearance.2 The proposed strategy may have the potential to
improve the two targets within one PD session.


CAPD

Figure 1: Modified cAPD graphic following Fischbach M. et al.




AAPD

Figure 2: Modified aAPD graphic following Fischbach M. et al.

Adapted APD is possible without extra fluids or a longer amount of time, with
the same glucose concentration.

The study results suggest that, compared with cAPD, targeting UF vs. clearance
separately, by varying dwell times and fill volumes may improve dialysis
adequacy with a reduction in metabolic burden.2


COMPARISON AFTER 45 DAYS1

Figure 3: Figure created based on study data from Fischbach, M. et al.,
comparing mean daily UF and sodium removal after 45 days, showing better UF
(+100 mL/session) and sodium removal (+14 mmol/session) for aAPD



Figure 4: Figure created based on study data from Fischbach, M. et al,. Higher
clearance with aAPD over glucose absorbed


SUMMARY OF POTENTIAL PATIENT BENEFITS AS REPORTED BY FISCHBACH ET AL2

Patient benefits

 * Improves ultrafiltration
 * Better sodium removal
 * Lower blood pressure
 * Promotes clearance: urea, creatinine, phosphate
 * Reduced metabolic load
    

Clinical value

 * Improved use of existing treatment resources: better ultrafiltration and
   clearance with same, low glucose concentration, fluid volume and treatment
   time compared to cAPD


APD MONITORING AND SUPPORT

Smart digital tools offer convenience for patients and caregivers in the comfort
of the patients’ homes.

3

TREATMENT

SUPPORT

 * A simple ordering process in combination with personal phone support ensures
   that patients can order materials anytime and anywhere
 * The delivery service ensures that PD solutions and disposables are delivered
   straight to your patient’s doorstep
 * The PD travel service enables patients to continue travelling as the required
   goods are directly sent to the patient’s holiday destination*

MONITOR

 * Streamlined PD therapy management through easy accessibility to therapy
   information via our PatientOnLine tool

* The service is not available in all countries. The availability of the service
and products must be clarified before planning or booking a vacation.


DISCLAIMER

Not all products and services are cleared or available for sale in all EU
countries. Check your country web site for details. 

Related content


PERITONEAL DIALYSIS – AN OVERVIEW

Fresenius Medical Care offers holistic solutions for CAPD and APD patients,
which includes supporting patients in preparing for PD with training solutions
and the set up.




CAPD

The stay•safe system helps patients with daily self-care CAPD treatment in a
simple and convenient way.


References

1 Roumeliotis A et al. Int Urol Nephrol 2021; 53(6):1149-1160

2 Fischbach M et al. Peritoneal Dial Int 2011; 31(4):450-458

3 Punzalan S et al. Journ of Kidn Care 2017; 2(5):262-267

4 Morales R et al. 2021 ISPD Congress, PO-40 (abstract, article submitted)

5 Unpublished data on file at Fresenius Medical Care DeutschlandGmbH; with
operation noise of LAeq 12-14 dB classification as “silently operating”
according to Berglund, Birgitta, Lindvall, Thomas, Schwela, Dietrich H & World
Health Organization. Occupational and Environmental Health Team. (1999).
Guidelines for community noise. World Health Organization, page 10, available as
download under https://apps.who.int/iris/handle/10665/66217; site was accessed
the last time 31/07/2023; 16:35 CET

6 Unpublished data on file at Fresenius Medical Care Deutschland GmbH (short
training times)

7 Brown EA et al. Perit Dial Int. 2020;40(3):244-253.

8 Tzamaloukas AH et al. Semin Dial 2008; 21(3):250-257

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