End stage renal disease (ESRD) differs from Acute renal failure (ARF) by not regaining normal / baseline renal function. ESRD is terminal, advanced and permanent renal failure beyond which life is possible only with Renal Replacement Therapy (RRT) in some form or other.

RRT can be offered either in the form of Renal Transplantation or by maintenance dialysis. Undoubtedly, Kidney Transplantation is the best. But, this is not available for many a patient for various reasons including medical, social, financial, legal, and others. Under these circumstances, maintenance dialysis is offered either by Haemodialysis (HD) or Peritoneal Dialysis (PD) or both.

PD when offered continuously daily or intermittently everyday is the next best to Kidney Transplantation and because of this reason its growth currently, is exponential.

A flexible catheter permanently placed within the two layers of peritoneal membrane allows movement of the fluid (Dialysate) in and out of the peritoneal cavity. The continuous presence of the smallest volume of fluid required to prevent uremia allows dialysis to go on continuously and permits the patient to be ambulant and hence, called Contiuous Ambulatary Peritoneal Dialysis (CAPD). In CAPD, 4 exchanges of 2 litre each in 24 hours, are carried out either manually or by a cycler to achieve adequate dialysis.

In Automated Nightly Peritoneal Dialysis (ANPD / Home Choice) the entire daytime is spared and allows the patient to carry on with his routine. During sleep and without any disturbance to sleep PD is carried out by an automated peritoneal dialysis cycler using 2 liter exchange of 5 cycles, each cycle lasting for 2 hours.

All patients with ESRD are potential candidates for CAPD / ANPD. Though cost is the limiting factor, this is the treatment of choice for patients with HaemoDynamic instability, vascular access problems, intolerance to HD, diabetes, extremes of age, associated comorbid conditions such as cardiac failure and chronic liver disease etc. It is a boon to persons who are otherwise very active.

This facility (CAPD / ANPD) is available only in few centres in India including the one in ours.