FP500TRENDS ON REAL-LIFE DELIVERED APD TREATMENTS: LOST OPPORTUNITIES FOR TAILORED PRESCRIPTIONS?. A MULTICENTER STUDY

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INTRODUCTION AND AIMS: Several softwares save on memory cards the prescribed and deliverd cycler PD (APD) treatments. This would allow us a perfect control of treatment, compliance and results for patients every day. However the scanty report focused on this topic is the proof of a missed opportunity for tailoring prescriptions. Our collaborative group join 20 PD public Hospitals since 2003 (more than 2.000 PD patients, one third on APD) METHODS: Multicenter (7 PD-Units) cohort study over patients starting Home-Choice-Cycler APD. Clinical data base (GCDP) were linked to APD-software’s (RenalSoft&Versia®). RESULTS: We analyse >107.00 daily APD treatments & prescriptions from 312 patients (aged 50.7 y; 65,5% males, 23,1% diabetics, 13,9% with a failed transplant, 21,9% previously on HD, and 63,5% from pre-dialysis). We divide them into two groups: starters on APD (148-naïve) and those coming from CAPD (163 post-CAPD).The main results summarized on tables 1-2 support the following messages: Descriptive basal. Data are shown as media and standard deviation or percentaje APD NaÏve patients are younger and less comorbid; their 1st prescription include lower dose and more frequent dry-day use than post-CAPD (16,6% Tydal; 2% OCPD, 24.8% Dry-Day, Other full APD). Usual regimen was 4 changes 2 litres and 85% use of Icodextrin ® for naïve and 5 cycles 2 litres and 77.8% Icodextrin ® for post-CAPD. We found no relationship between BMI and infusion or total PD volume. Usual Tydal regimen include: standard total volume, high interchange % (median 80%) and few cycles; based more in catheter problems than in a real Tydal for high efficacy. APD-naïve prescription tend to use day time progressively while post-CAPD remain on dry-day (different clinical phenotypes). Drain and infusion lasted for 28.4% of total prescribed time and didn’t change during follow-up. Real dwell time was reduce by 12 min/cycle in 1st month and increased to 16 min/cycle in the last month. The adequacy between prescribed and delivered treatment is fairly good and 70.8% change less than 5% from prescribed; 9,5% need to extend total time significantly. In summary: we have described the patient profile associated to naïve APD use (based on life style for youngers) and the main routine clinical practices. We are losing an opportunity for individually adapted AP-prescriptions and to help us to improve our clinical practice. Started and last prescription CONCLUSIONS: We have described the patient profile associated to naïve APD use (based on life style for youngers) and the main routine clinical practices. We are loosing an opportunity for individualy adapted AP-prescriptions; a lot of information is waiting to help us to improve our clinical practice.

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