Evolution of continuous flow peritoneal dialysis and the current state of the art.

Continuous flow peritoneal dialysis (CFPD) was first conceived more than three decades ago in an attempt to enhance peritoneal clearances using the continuous flow technique. Its progress was halted by technical limitations and by the high cost required to generate large volumes of dialytic solution. The recent demand for higher PD doses and technical innovations have revived the interest in this therapy. This article reviews the basic mechanical principles governing CFPD, its potential advantages and disadvantages, and the various methods to generate dialysate. Recent clinical experiences strongly suggest that CFPD can achieve higher small solute clearances than any modality of conventional PD or three times a week hemodialysis, and perhaps comparable to those obtained with daily hemodialysis. Attention can now be directed at improving peritoneal access and developing systems compatible with current reimbursement.