Changes in Peritoneal Equilibration Test Values during Long-Term Peritoneal Dialysis in Peritonitis-Free Children

2001 ◽  
Vol 21 (2) ◽  
pp. 180-186 ◽  
Author(s):  
Atsunori Yoshino ◽  
Masataka Honda ◽  
Masamichi Fukuda ◽  
Yoshinori Araki ◽  
Hiroshi Hataya ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Dwell Time ◽  
Peritoneal Equilibration Test ◽  
Remarkable Change ◽  
Plasma Ratio ◽  
Glucose Ratio ◽  
Most Significant Change ◽  
The Mean ◽  
Significant Change

Little is known about the changes in peritoneal equilibration test (PET) values in children on long-term peritoneal dialysis (PD). In the present study, a PET was carried out every 6 months in 39 children (mean age 8.8 ± 5.5 years) undergoing PD for 6 to 85 months (mean 36.9 ± 23.1 months). Patients experiencing peritonitis were excluded. Both D/P creatinine (dialysate-to-plasma ratio of creatinine at 4 hours) and D/D0 glucose (ratio of dialysate glucose at 4 hours’ dwell time to dialysis glucose at 0 dwell time) were measured 195 times in this series of patients. No remarkable change was found for D/P creatinine or D/D0 glucose during the first 24 months of PD but thereafter, D/P creatinine increased gradually and D/D0 glucose decreased gradually. Mean D/P creatinine increased significantly after the first 24 months of PD: from 0.66 ± 0.12 during the first 24 months, to 0.70 ± 0.09 after 25 months and more of PD ( p = 0.0051). Mean D/D0 glucose decreased significantly after 24 months of PD: from 0.42 ± 0.09 during the first 24 months, to 0.38 ± 0.08 after 25 months and more of PD ( p = 0.0015). The most significant change for both D/P creatinine and D/D0 glucose occurred after 24 months of PD. It seems reasonable to consider the mean PET values at 24 months of PD as the standard PET values.

Results of Peritoneal Equilibration Test during Treatment with Polyglucose Dialysis Solution

2002 ◽  
Vol 22 (3) ◽  
pp. 357-364 ◽  
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.

Re-Evaluation of Solute Transport Groups Using the Peritoneal Equilibration Test

1999 ◽  
Vol 19 (5) ◽  
pp. 438-441 ◽  
Author(s):  
Roger A. Rodby ◽  
Catherine A. Firanek ◽  
Ann L. Sarpolis
Keyword(s):  
Peritoneal Dialysis ◽  
Solute Transport ◽  
Gaussian Distribution ◽  
Patient Population ◽  
Population Data ◽  
Peritoneal Equilibration Test ◽  
Plasma Ratio ◽  
The Mean ◽  
Standard Deviations

Objective To determine if the previously described peritoneal equilibration test (PET)-determined solute transport groups, as defined by Twardowski, fit our patient population. Design We reviewed the 195 initial standardized PETs (on 195 patients) performed through our peritoneal dialysis program since 1989. Using the method originally defined by Twardowski using the means and standard deviations of the PET-determined dialysis/plasma ratio (D/P) of creatinine and dialysate-to-0 hour dialysate (D/D0) glucose values, transport groupings for our patient population were determined. Comparisons were then made between patient populations. Results The mean 4-hour D/P creatinine in our patients was 0.70 ± 0.10. This compares to a mean of 0.65 ± 0.15 as determined by Twardowski, and indicates that our patients have higher mean solute transport characteristics and tighter ranges within transport groups than previously reported. Only 2% of our patients fell into the previously described low (L) range, with 30% low average (LA), 51% high average (HA), and 17% high (H). Using our data, we would redefine the groups by a 4-hour D/P creatinine as L < 0.60, LA = 0.60 – 0.70, HA = 0.70 – 0.80, and HA > 0.80. Using these values, our population fits a Gaussian distribution with 17% L, 31% LA, 33% HA, and 19% H. Conclusion Our patients have higher mean solute transport and tighter ranges within transport groups than previously reported. Using the previously defined PET-determined transport groupings, low transporters are particularly underestimated. If our population data are representative of the peritoneal dialysis population as a whole, these ranges should be redefined.

Compliance Study in Peritoneal Dialysis Using Pdadequest Software

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 176-178 ◽  
Author(s):  
Gianpaolo Amici ◽  
Giusto Viglino ◽  
Giovambattista Virga ◽  
Carmen Gandolfo ◽  
Giorgio Da Rin ◽  
...  
Keyword(s):  
Mathematical Model ◽  
Peritoneal Dialysis ◽  
Filtration Rate ◽  
Threshold Value ◽  
Control Group ◽  
Case Histories ◽  
Peritoneal Equilibration Test ◽  
Software Model ◽  
Noncompliant Patient ◽  
The Mean

Poor compliance in peritoneal dialysis (PD) is a significant cause of dropout and morbidity. PD Adequest software, which, through a mathematical model, predicts the effect of the dialysis prescription on the basis of the peritoneal transport, may be used to identify the noncompliant patient. Fifty patients from two dialysis centers, aged 65.9±1.5 years and on PD for 28.6±4.7 months, were studied. A peritoneal equilibration test (PET) was carried out and 24hour urine and dialysate were collected. Total weekly creatinine clearance (CrCI, L/week/1.73 m2) was calculated, as well as the glomerular filtration rate [(GFR), mL/min, mean CrCI and urea nitrogen clearance (UNCI)]. The dialytic schedules used were then introduced into the program and the parameters were recalculated using the software model. Nine patients considered noncompliant from their case histories were used to assess the differences of reference between expected and measured values. The control group was significantly different from the noncompliant group in the percentage of the CrCI and the serum creatinine (sCR) differences. The noncompliance threshold value was calculated from the mean of the lower 95% confidence interval of the compliant group and the higher one of the noncompliant group (-5.3%) for CrCI and vice versa for sCR (+10%), which behaved to the contrary. Reassessing the patients, 11 (22%) were identified as probably noncompliant.

scholarly journals Peritoneal Morphology after Long-Term Peritoneal Dialysis with Biocompatible Fluid: Recent Clinical Practice in Japan

2012 ◽  
Vol 32 (2) ◽  
pp. 159-167 ◽  
Author(s):  
Nobuhiro Ayuzawa ◽  
Yoshitaka Ishibashi ◽  
Yutaka Takazawa ◽  
Haruki Kume ◽  
Toshiro Fujita
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Practice ◽  
University Hospital ◽  
Dialysis Therapy ◽  
Compact Zone ◽  
Peritoneal Biopsy ◽  
The Mean ◽  
The Impact ◽  
Peritoneal Morphology

♦BackgroundMorphology changes of the peritoneal membrane after long-term peritoneal dialysis (PD) consist of denudation of peritoneal mesothelial cells, interstitial sclerosis, and hyalinizing vasculopathy. Those changes are considered to be the result of uremia and bioincompatible effects of conventional acidic lactate-buffered dialysate with glucose degradation products (GDPs). In the last decade, biocompatible dialysate with neutral pH and low GDPs has become widely used. Clinical practice has been modified in Japan, especially for anuric patients, and now includes the use of hybrid therapy. The impact on peritoneal morphology has not been well reported.♦ ObjectiveThe aim of the present study was to investigate the long-term effect on peritoneal morphology and function of biocompatible fluid use and current clinical practice in Japan, including hybrid dialysis therapy.♦MethodsWe evaluated peritoneal biopsy specimens from patients who had undergone PD for more than 3 years. We used the average peritoneal thickness (APT) of the submesothelial compact zone as a marker of interstitial sclerosis and the lumen/vessel diameter ratio (L/V ratio) at postcapillary venules as a marker of hyalinizing vasculopathy. Demography and other data for the patients, including dialysate-to-plasma (D/P) ratio of creatinine, were obtained at baseline and every 6 months by peritoneal equilibration test.♦ResultsBetween 2002 and 2009, 110 patients started PD therapy with biocompatible dialysate at Tokyo University Hospital. Among them, 11 patients (8 men, 3 women; age: 54.2 ± 11.8 years; 1 with diabetes mellitus) were enrolled into this morphology study. The mean duration of PD in this group was 61 ± 11.3 months, and the mean time to peritoneal biopsy was 58 ± 15.1 months. The median APT was 180 μm (96 – 1424 μm), and the median L/V ratio was 0.66 (0.46 – 0.74). No obvious correlations between APT, L/V ratio, and PD duration were detected. The D/P creatinine of the 11 patients was maintained at a favorably low value, comparable with that of the other 99 patients.♦ConclusionsPeritoneal dialysis therapy using biocompatible dialysate in conjunction with modification of clinical practice may minimize the progression of peritoneal interstitial sclerosis and hyalinizing vasculopathy, preserving favorable peritoneal function for more than 3 years.

Evaluation of the Peritoneal Equilibration Test in Children on Chronic Peritoneal Dialysis

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 260-262 ◽  
Author(s):  
Alberto Edefonti ◽  
Marina Picca ◽  
Raffaele Galato ◽  
Sophie Guez ◽  
Marisa Giani ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Dwell Time ◽  
Glucose Solution ◽  
Transport Rate ◽  
Chronic Peritoneal Dialysis ◽  
Automated Peritoneal Dialysis ◽  
Peritoneal Equilibration Test ◽  
Blood Samples ◽  
Mean Values ◽  
Significant Difference

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.

scholarly journals A Model To Estimate Glucose Absorption in Peritoneal Dialysis: A Pilot Study

Kidney360 ◽  
2020 ◽  
Vol 1 (12) ◽  
pp. 1373-1379
Author(s):  
Suman Krishna Kotla ◽  
Ashish Saxena ◽  
Ramesh Saxena
Keyword(s):  
Peritoneal Dialysis ◽  
Pilot Study ◽  
Dwell Time ◽  
Caloric Intake ◽  
Glucose Absorption ◽  
Metabolic Effects ◽  
Accurate Estimation ◽  
The Mean ◽  
The Individual ◽  
Glucose Estimation

BackgroundGlucose absorption in patients on peritoneal dialysis (PD) may contribute to adverse metabolic effects. Previous studies on glucose absorption were done on patients on continuous ambulatory PD, with a long dwell time. However, the growing majority of contemporary patients on PD perform automated PD with a short dwell time. Moreover, membrane characteristics and dwell time determine small-solute transport across the peritoneal membrane.MethodsIn our pilot study, we used data from the peritoneal equilibration test (PET) to develop a model to estimate glucose absorption. In six randomly selected patients on PD, we calculated actual glucose absorption from directly measuring effluent glucose concentration. We then used the R programming language to create a nonlinear, least-squared regression model, inputting PET data, D2/D0, and D4/D0 to generate an exponential decay curve. This model was then used to estimate the fraction of glucose remaining in the dialysate at a particular dwell time t (Dt/D0). Daily glucose absorption was calculated by multiplying 1−Dt/D0 with the amount of glucose the patient was exposed to in 24 hours.ResultsWe observed the mean glucose absorption (89.7±28.8 g/d), as measured from the effluent, very close to our estimate (88.12±28.9 g/d), and the difference between the glucose estimation and actual absorption was not statistically significant (P>0.05), with "W" value of 8. After validating our hypothesis, we randomly selected an independent cohort of 11 patients with ESKD who were on various PD modalities and analyzed their data. We observed that the mean daily glucose absorption of 62.7±24.5 g (27.98–110.35 g), much lower than that reported in the literature, depends on dwell times and membrane characteristics in addition to the amount of glucose absorption in the cohort.ConclusionsOur model provides a simple tool for estimating glucose absorption and caloric load in contemporary patients on PD. Hopefully, the accurate estimation of caloric load and the incorporation of it into the daily caloric intake of the individual will help to reduce metabolic consequences of hyperglycemia and weight gain and improve overall outcomes of PD.

The Mesothelial Cells in CAPD Effluent and Their Relation to Peritonitis Incidence

1991 ◽  
Vol 11 (1) ◽  
pp. 22-26 ◽  
Author(s):  
Michiel G.H. Betjes ◽  
Harry J. Bos ◽  
Raymond T. Krediet ◽  
Lambertus Arisz
Keyword(s):  
Dwell Time ◽  
Total Yield ◽  
Mesothelial Cells ◽  
Total Cell ◽  
Lower Percentage ◽  
Total Cell Count ◽  
The Mean ◽  
Turn Over ◽  
Peritoneal Dialysis Effluent

The total cell count and cell differentiation of the overnight peritoneal dialysis effluent (PDE) was analysed in 34 long-term CAPD patients. The mean percentage and yield of mesothelial cells were 3.1% and 0.17 × 106 per PDE. There was a significant lower percentage and yield of mesothelial cells in the PDE of patients with a peritonitis incidence (PI) of more than 2 episodes a year. Independent of dwell time, a positive correlation between the total yield of leucocytes and the yield of mesothelial cells was found. No relation between the amount of phospholipids in the PDE and the yield of mesothelial cells could be shown. Mesothelial cells in the PDE are probably reflecting the turn-over rate of a reactive mesothelium. Whether a low turn-over rate of the mesothelium is causing or is caused by a high PI needs further investigation.

The 1997 Report of the Japanese National Registry Data on Pediatric Peritoneal Dialysis Patients

1999 ◽  
Vol 19 (2_suppl) ◽  
pp. 473-478 ◽  
Author(s):  
Masataka Hondaa
Keyword(s):  
Peritoneal Dialysis ◽  
Survival Rate ◽  
Survival Rates ◽  
National Registry ◽  
Catheter Survival ◽  
Technique Survival ◽  
The Mean ◽  
National Registry Data ◽  
Patient Survival Rate

Objective We have collected data on pediatric patients less than 16 years of age from the National Registry of Chronic Peritoneal Dialysis (PD). We present our experience with this population. Design The database details the patient numbers, age, outcome, cause of death, reason for terminating PD therapy, type of PD therapy, peritonitis, and catheter survival. Patients Of 807 patients, 70 patients (8.7%) were under 1 year of age, and 268 patients (33.2%) were under 6 years of age, clearly indicating that PD was the treatment of choice in young children. The duration on PD was 5 years or more in 200 patients (24.8%), which showed an increase in long-term PD patients from 11% in 1991. Patients on automated PD (APD) increased to 75% in 1997 from 9% in 1991. Results The outcomes for the total patient population of 807 as of the end of 1997 is: 253 patients (31.4%) were being successfully treated with PD, 87 patients (10.8%) died, 238 patients (29.5%) received a kidney transplant, and 121 (15.0%) were transferred to hemodialysis. The patient survival rate was 91% in 3 years and 86% in 5 years. The technique survival rate was 83% in 3 years and 71% in 5 years. The rate of peritonitis was 1 episode per 30 patient -months. The mean catheter duration was 2.25 years. Conclusion The patient and technique survival rates, the peritonitis rate, and the catheter survival improved recently. However, these data were worse in younger children (less than 6 years of age), indicating that extra-careful management is needed for this young age group.

Determination of Individual Ultrafiltration Time (Apex) and Purification Phosphate Time by Peritoneal Equilibration Test: Application to Individual Peritoneal Dialysis Modality Prescription in Children

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 557-561 ◽  
Author(s):  
Michel Fischbach ◽  
Ahmed Lahlou ◽  
Didier Eyer ◽  
Philippe Desprez ◽  
Jean Geisert
Keyword(s):  
Peritoneal Dialysis ◽  
Dwell Time ◽  
Wide Distribution ◽  
Individual Choice ◽  
Major Goal ◽  
Peritoneal Equilibration Test ◽  
Test Application ◽  
The Individual ◽  
Over Time ◽  
Solute Clearance

Efficiency of peritoneal dialysis (PD) is dependent on adequate ultrafiltration (UF) and purification (solute clearance). These two goals apparently seem to conflict in terms of duration of dwells: short dwell time enhances UF capacity and, conversely, long dwell time enhances solute clearance. Peritoneal equilibration test (PET) allows an approach to the ultrafiltration time: the point at which the over time dialysate urea saturation and glucose desaturation curves cross, called APEX time. PET also allows an approach to the purification time: the point at which dialysate-to-plasma (DIP) concentration ratios over time are high. Because of the value of phosphate as a uremic factor of morbidity, we have chosen the time at which DIP phosphate is equal to 0.6 as a purification phosphate dwell time (PPT). A total of 17 patients were studied, over a five-year period, allowing 142 determinations. APEX times (range 18 71 min) and PPT (range 105 -238 min) were spread over a wide distribution. PPT and APEX times were significantly shorter in children younger than three years of age than in children older than ten years of age. PPT were nearly four times longer than APEX times. Knowledge of these conflicting ultrafiltration and purification times should help, in our view, in the individual choice of the PD modality: if UF is the major goal, short dwell times should be used (automated PD); if purification is the major goal, long dwell times should be used, as in continuous ambulatory peritoneal dialysis; if both are the target goal, tidal PD should be discussed.

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