Peritoneal Equilibration Test Curves and Adequacy of Dialysis in Children on Automated Peritoneal Dialysis

The peritoneal equilibration test (PET) is routinely performed in adults treated with chronic peritoneal dialysis to assess the peritoneal transport rate and to optimize treatment prescription. Only a few and not well-standardized studies on the PET have been reported in children. Twenty-six PETs were performed In 16 children, mean age 10.9±4.9 years, mean body weight (BW) 26.8±11.9 kg, treated with nightly intermittent peritoneal dialysis (NIPD). The PET was performed according to Twardowski. Forty mL/kg BW of 2.27% glucose solution were Infused at a rate of 10 mL/kg BW every 2 minutes. In the simplified test, dialysate samples were taken at dwell times 0, 2 and 4 hours for glucose and creatinine. A blood sample was taken after a 2-hour dwell time for the same parameters. The standard PET (8 patients) consisted of dialysate samples at 0, 15, 30, 60, 120, and 240 minutes and blood samples at 0 and 240 minutes. Mean DIP ratio for corrected creatinine and DIDo ratio for glucose at 2 hours were 51.6±11.6 and 50.4±9, respectively; at 4 hours 69.6± 12 and 34.4±9.8, respectively. There was good correlation between DIP creatinine and DIDo glucose at 4 hours (p<0.0001). Patients were classified as high (3 cases), high-average (5), low-average (6), and low (2) transporters. A statistically significant difference was found between the curves obtained by the simplified PET and those of the standard PET In the first hour (r=0.66; p<0.05). In conclusion, the PET, modified for use in children, gave reliable and reproducible results. Mean values of DIP creatinine for children were higher and DIDo glucose lower than those of adults as reported by Twardowskl. A consistent percentage of children had, nevertheless, a low-average or low transport rate. Standard PET is required in case of automated peritoneal dialysis prescription.

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Influence of the Preceding Dwell Time on the Peritoneal Equilibration Test with 3.86% Glucose Solution in Automated Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2009.00068 ◽

2010 ◽

Vol 30 (1) ◽

pp. 95-98 ◽

Cited By ~ 1

Author(s):

Trijntje Cnossen ◽

Charles Beerenhout ◽

Watske Smit ◽

Constantijn Konings ◽

Jeroen Kooman ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Solute Transport ◽

Dwell Time ◽

Fluid Transport ◽

Glucose Solution ◽

Automated Peritoneal Dialysis ◽

Peritoneal Equilibration Test ◽

Sodium Sieving ◽

Transport Type

ObjectiveThe peritoneal equilibration test (PET) using 3.86% glucose solution is preceded by a long dwell with 3.86% glucose solution. A point of concern in patients treated with automated peritoneal dialysis (APD) is the influence of the preceding short nightly dwells on the results of a standardized PET. The aim of the study was to compare net ultrafiltration, small solute transport, sodium sieving, and solute transport type between a PET preceded by a long night dwell and one preceded by short (APD) dwells.Patients and Methods13 stable APD patients (mean age 60 ± 15 years; mean duration of peritoneal dialysis 31 ± 15 months) underwent 2 PETs: 1 preceded by short nightly dwells (PET A) and 1 preceded by a long night dwell (PET B).ResultsBoth PETs were performed within a mean period of 8 (range 5 – 11) days. Mean total ultrafiltration of PET A was 626 ± 218 mL and PET B was 644 ± 223 mL (NS). The 4-hour results of both tests for dialysate-to-plasma (D/P) ratios of creatinine and urea, Dt/D0ratios of glucose, and the dip in D/P sodium (sodium sieving) were similar. Classification of transport categories was identical for 10 of 13 patients.ConclusionIn APD, the preceding dwell time of a 3.86% glucose PET does not influence fluid transport, solute transport, or transport type.

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Adequacy of Dialysis in Automated Peritoneal Dialysis: A Clinical Experience

Peritoneal Dialysis International ◽

10.1177/089686089701700506 ◽

1997 ◽

Vol 17 (5) ◽

pp. 442-448 ◽

Cited By ~ 5

Author(s):

Ana Marla Fernández Rodriguez ◽

Nicanor Vega Dlaz ◽

Leocadia Palop Cubillo ◽

Eduardo Baamonde Laborda ◽

Adelaida Morales Umpierrez ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Automated Peritoneal Dialysis ◽

Urea Clearance ◽

Peritoneal Equilibration Test ◽

Helpful Tool ◽

Remarkable Improvement ◽

Continuous Cycling ◽

Before And After ◽

Mean Time ◽

Tidal Peritoneal Dialysis

Objectives To compare the peritoneal clearances of urea and creatinine in continuous ambulatory peritoneal dialysis (CAPD) with three types of automated peritoneal dialysis (APD): continuous cycling peritoneal dialysis (CCPD), 50% tidal peritoneal dialysis (TPD), and 25% TPD and to assess the usefulness of the peritoneal equilibration test (PET) in predicting peritoneal clearances in overnight APD. Patients Eleven uremic patients (mean age 44.5 ± 15.45 years with a mean time on dialysis of 42.63 ± 25.62 months) were included in the study. Measurements PET for urea and creatinine following Twardowski's method. Peritoneal clearances for urea and creatinine CAPD: samples of blood and dialysate within 24 hours. APD: blood mean levels of urea and creatinine before and after nighttime dialysis. Dialysate: urea and creatinine in nocturnal and daytime dialysate. Results Peritoneal clearance of creatinine was 38.14 ± 9.99 L/week/1.73 m2 in CAPD, 44.28 ± 12.4 L/week/1.73 m2 in CCPD, 50.07 ± 17.86 L/week/1.73 m2 in 50% TPD (p < 0.05) and 40.18 ± 6.65 L/week/1.73 m2 in 25% TPD. Peritoneal clearance of urea improved significantly in the three modalities of APD: 51.91 ± 12.58 L/week/1.73 m2 in CAPD; 66.7 ± 9.9 L/week/1. 73 m2 in CCPD (p < 0.05); 76.3 ± 14.5 L/week/1. 73 m2 in 50% TPD (p < 0.001) and 64.3 ± 11.4 L/week/1.73 m2 in 25% TPD (p < 0.05). The dialysatel plasma (DIP) ratio of creatinine at 30,60, 120,180, and 240 minutes showed significant correlation with nighttime APD clearance. Nevertheless, only the DIP ratio of urea at 30, 60, and 120 minutes correlated with overnight APD clearance. Conclusions A remarkable improvement was observed with APD regarding the clearance of urea mainly when 50% tidal peritoneal dialysis was used, whereas it was less noticeable in the clearance of creatinine. The PET is a helpful tool in predicting overnight peritoneal clearances of creatinine but it is less useful in predicting urea clearance.

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Pharmacokinetics of culture-directed antibiotics for the treatment of peritonitis in automated peritoneal dialysis: A systematic narrative review

Peritoneal Dialysis International ◽

10.1177/0896860821990528 ◽

2021 ◽

Vol 41 (3) ◽

pp. 261-272

Author(s):

Chau Wei Ling ◽

Kamal Sud ◽

Connie Van ◽

Syed Tabish Razi Zaidi ◽

Rahul P. Patel ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Case Reports ◽

Plasma Concentrations ◽

Case Series ◽

Therapeutic Drug ◽

Pharmacokinetic Studies ◽

Pharmacokinetic Data ◽

Automated Peritoneal Dialysis ◽

Final Study ◽

Drug Plasma

The objectives of this study were to provide a summary of the pharmacokinetic data of some intraperitoneal (IP) antibiotics that could be used for both empirical and culture-directed therapy, as per the ISPD recommendations, and examine factors to consider when using IP antibiotics for the management of automated peritoneal dialysis (APD)-associated peritonitis. A literature search of PubMed, EMBASE, Scopus, MEDLINE and Google Scholar for articles published between 1998 and 2020 was conducted. To be eligible, articles had to describe the use of antibiotics via the IP route in adult patients ≥18 years old on APD in the context of pharmacokinetic studies or case reports/series. Articles describing the use of IP antibiotics that had been recently reviewed (cefazolin, vancomycin, gentamicin and ceftazidime) or administered for non-APD-associated peritonitis were excluded. A total of 1119 articles were identified, of which 983 abstracts were screened. Seventy-three full-text articles were assessed for eligibility. Eight records were included in the final study. Three reports had pharmacokinetic data in patients on APD without peritonitis. Each of cefepime 15 mg/kg IP, meropenem 0.5 g IP and fosfomycin 4 g IP given in single doses achieved drug plasma concentrations above the minimum inhibitory concentration for treating the susceptible organisms. The remaining five records were case series or reports in patients on APD with peritonitis. While pharmacokinetic data support intermittent cefepime 15 mg/kg IP daily, only meropenem 0.5 g IP and fosfomycin 4 g IP are likely to be effective if given in APD exchanges with dwell times of 15 h. Higher doses may be required in APD with shorter dwell times. Information on therapeutic efficacy was derived from case reports/series in individual patients and without therapeutic drug monitoring. Until more pharmacokinetic data are available on these antibiotics, it would be prudent to shift patients who develop peritonitis on APD to continuous ambulatory peritoneal dialysis, where pharmacokinetic information is more readily available.

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Relationship between Vascular Calcification, Protein-Energy Wasting Syndrome, and Sarcopenia in Maintenance Automated Peritoneal Dialysis

Life ◽

10.3390/life11070666 ◽

2021 ◽

Vol 11 (7) ◽

pp. 666

Author(s):

Gustavo Leal-Alegre ◽

Claudia Lerma ◽

Gabriela Leal-Escobar ◽

Bernardo Moguel-González ◽

Karen Belén Martínez-Vázquez ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Peritoneal Dialysis ◽

Vascular Calcification ◽

Automated Peritoneal Dialysis ◽

Dialysis Patients ◽

Protein Energy Wasting ◽

Wasting Syndrome ◽

Protein Energy ◽

Inflammation Score

Vascular calcifications affect 80% to 90% of chronic kidney disease patients and are a predictive factor of cardiovascular mortality. Sarcopenia and protein-energy wasting syndrome are also associated with mortality. The aim was to assess the relationship between vascular calcification, sarcopenia, and protein-energy wasting syndrome (PEW) in automated peritoneal dialysis patients. Fifty-one maintenance automated peritoneal dialysis patients were included (27 were male, mean age 39 ± 14 years). Vascular calcification was assessed based on abdomen, pelvis, and hand radiographs. Sarcopenia was assessed with bioimpedance analysis and a hand grip strength test. The Malnutrition–Inflammation Score and the presence of PEW were also assessed. Vascular calcification was present in 21 patients (41.2%). Univariate logistic regression analysis showed that age (p = 0.001), Malnutrition–Inflammation Score (p = 0.022), PEW (p = 0.049), sarcopenia (p = 0.048), and diabetes (p = 0.010) were associated with vascular calcification. Multivariate logistic regression analysis showed that age (p = 0.006) was the only variable associated independently with vascular calcification. In conclusion, there is association between vascular calcification, PEW, and sarcopenia in patients with maintenance automated peritoneal dialysis. These associations are not independent of age. This demonstrates the importance of nutritional status in the prevention of vascular calcification.

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Results of Peritoneal Equilibration Test during Treatment with Polyglucose Dialysis Solution

Peritoneal Dialysis International ◽

10.1177/089686080202200310 ◽

2002 ◽

Vol 22 (3) ◽

pp. 357-364 ◽

Cited By ~ 1

Author(s):

Alicja E. Grzegorzewska ◽

Danuta Antczak-Jȩdrzejczak ◽

Magdalena Leander

Keyword(s):

Peritoneal Dialysis ◽

Dwell Time ◽

Control Period ◽

University Hospital ◽

Control Group ◽

Peritoneal Equilibration Test ◽

Dialysis Unit ◽

Dialysis Solution ◽

Glucose Ratio ◽

Peritoneal Permeability

Background Results of peritoneal equilibration test (PET) suggest prolonged effect of polyglucose dialysis solution (PG-DS) on peritoneal permeability. Objectives An evaluation of dialysate-to-plasma ratio (D/P) of urea, D/P creatinine, and D/D0 glucose (ratio of dialysate glucose at designated dwell time to dialysate glucose at 0 dwell time), and mass transfer area coefficients (KBD) of these solutes in PET before introduction, during administration, and after discontinuation of PG-DS in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Design Single-center prospective study with PG-DS; retrospective selection of the control group. Setting Peritoneal dialysis unit in a university hospital. Patients Fourteen patients (11 males; age 45.1 ± 8.5 years) treated with CAPD for 17.5 ± 9.9 months. 7.5% PG-DS was used for the overnight exchange. After discontinuation of the PG-DS, standard dialysis solutions, as previously used, were reintroduced. The control group was selected to match both CAPD duration and peritoneal permeability of the patients in the PG-DS group at the start of the study. Methods Standard PET was carried out at 1.6 ± 0.8 months before the introduction of PG-DS (study period I, n = 14), after 1.2 ± 0.6 months’ use of PG-DS (study period II, n = 14), after 4.4 ± 0.8 months’ use of PG-DS (study period III, n = 11), after 8.8 ± 2.2 months’ use of PG-DS (study period IV, n = 9), and at 2.0 ± 0.6 months after PG-DS discontinuation (study period V, n = 11). Patients in the control group underwent PET at similar time intervals (control periods I – V). Results In the PG-DS group, a tendency toward increased peritoneal permeability for urea and creatinine was shown during the consecutive study periods. D/D0 glucose was significantly higher only in the PET performed during use of PG-DS (periods II – IV) compared to results obtained in period I. In the control group, both D/P and KBD of both urea and creatinine remained unchanged, but KBD glucose was higher in the first 2 hours of the PET in control period V compared to respective values in control period III. Conclusion Changes in peritoneal permeability are observed in CAPD patients treated with PG-DS. These changes may be at least partially related to the administration of polyglucose.

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Intraperitoneal hydrostatic pressure and flow characteristics of peritoneal catheters in automated peritoneal dialysis

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfh145 ◽

2004 ◽

Vol 19 (3) ◽

pp. 754-754

Author(s):

R. Scanziani ◽

B. Dozio ◽

I. Baragetti ◽

S. Maroni

Keyword(s):

Peritoneal Dialysis ◽

Hydrostatic Pressure ◽

Flow Characteristics ◽

Automated Peritoneal Dialysis

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A New Method to Increase Ultrafiltration in Peritoneal Dialysis: Steady Concentration Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2016.00007 ◽

2016 ◽

Vol 36 (5) ◽

pp. 555-561 ◽

Cited By ~ 7

Author(s):

Vicente Pérez-Díaz ◽

Alfonso Pérez-Escudero ◽

Sandra Sanz-Ballesteros ◽

Guadalupe Rodríguez-Portela ◽

Susana Valenciano-Martínez ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Glucose Concentration ◽

Fluid Overload ◽

Glucose Solution ◽

Osmotic Gradient ◽

Single Session ◽

Peritoneal Equilibration Test ◽

Peritoneal Transport ◽

Constant Rate ◽

Limited Power

Background Peritoneal dialysis (PD) has limited power for liquid extraction (ultrafiltration), so fluid overload remains a major cause of treatment failure. Methods We present steady concentration peritonal dialysis (SCPD), which increases ultrafiltration of PD exchanges by maintaining a constant peritoneal glucose concentration. This is achieved by infusing 50% glucose solution at a constant rate (typically 40 mL/h) during the 4-hour dwell of a 2-L 1.36% glucose exchange. We treated 21 fluid overload episodes on 6 PD patients with high or average-high peritoneal transport characteristics who refused hemodialysis as an alternative. Each treatment consisted of a single session with 1 to 4 SCPD exchanges (as needed). Results Ultrafiltration averaged 653 ± 363 mL/4 h — twice the ultrafiltration of the peritoneal equilibration test (PET) (300 ± 251 mL/4 h, p < 0.001) and 6-fold the daily ultrafiltration (100 ± 123 mL/4 h, p < 0.001). Serum and peritoneal glucose stability and dialysis efficacy were excellent (glycemia 126 ± 25 mg/dL, peritoneal glucose 1,830 ± 365 mg/dL, D/P creatinine 0.77 ± 0.08). The treatment reversed all episodes of fluid overload, avoiding transfer to hemodialysis. Ultrafiltration was proportional to fluid overload ( p < 0.01) and inversely proportional to final peritoneal glucose concentration ( p < 0.05). Conclusion This preliminary clinical experience confirms the potential of SCPD to safely and effectively increase ultrafiltration of PD exchanges. It also shows peritoneal transport in a new dynamic context, enhancing the influence of factors unrelated to the osmotic gradient.

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MO710GALECTIN-3, IS IT A NEW PLAYER IN PERITONEAL INFLAMMATION AMONG PATIENTS UNDERGOING PERITONEAL DIALYSIS?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab101.0032 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Yael Einbinder ◽

Keren Cohen-Hagai ◽

Sydney Benchetrit ◽

Tali Zitman-Gal

Keyword(s):

Cell Culture ◽

Peritoneal Dialysis ◽

Endothelial Cell ◽

Protein Expression ◽

Inflammatory Process ◽

Peritoneal Membrane ◽

Peritoneal Equilibration Test ◽

Endothelial Cell Culture ◽

Dialysis Vintage ◽

Mrna And Protein Expression

Abstract Background and Aims Peritoneal dialysis (PD) is a common used method for renal replacement therapy. Prolonged PD treatment causes structural and functional changes in the peritoneal membrane which are attributed to local inflammatory process in the peritoneal cavity. Galectin-3 (Gal-3) is a galactoside-binding lectin with pro-inflammatory and pro-fibrotic effects. The aim of this study was to assess correlation between Gal-3 serum and dialysate effluent levels with peritoneal membrane transport characteristics. Method Gal-3 levels in serum and dialysate effluent were measured simultaneously in prevalent PD patients in morning visit or during peritoneal equilibration test (PET). Gal-3 levels were correlated with clinical and laboratory parameters. Interlukin (IL) -6 levels were measured in dialysate effluent. Gal-3 mRNA and protein expression were evaluated after exposure of primary endothelial cell culture to several dialysate solutions. Results 37 PD patients were included in the study; mean age was 65.7±13.1 years, mean dialysis vintage was 17.5±13 months. Gal-3 levels in dialysate effluent correlated with peritoneal equilibration test (PET) results (0.663, p=0.005) and effluent IL-6 levels (0.674, p=0.002) but not with serum Gal-3 levels or dialysis vintage. Patients with high PET results had higher effluent Gal-3 levels as compared average low PET results. In multivariate regression analysis effluent IL-6 level was the most dominant predictor of effluent Gal-3 levels. Gal-3 mRNA and protein expression in primary endothelial cell culture were not affected by stimulation with dialysate solutions. Conclusion Our study demonstrated presence of Gal-3 within the dialysate effluent in PD patients. Gal-3 levels correlated with peritoneal membrane transport characteristics and effluent IL-6 levels suggesting a role in the inflammatory process within the peritoneal cavity.

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