Evaluation of the Peritoneal Equilibration Test in Children on Chronic 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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Peritoneal Transport in Peritoneal Dialysis Patients Using Glucose-Based and Amino Acid-Based Solutions

Peritoneal Dialysis International ◽

10.1177/089686080702700514 ◽

2007 ◽

Vol 27 (5) ◽

pp. 544-553 ◽

Cited By ~ 19

Author(s):

Anna Olszowska ◽

Jacek Waniewski ◽

Andrzej Werynski ◽

Björn Anderstam ◽

Bengt Lindholm ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Amino Acid ◽

Total Protein ◽

Glucose Solution ◽

Transport Coefficients ◽

Transport Rate ◽

Mean Values ◽

Peritoneal Transport ◽

Significant Difference ◽

Dialysate Volume

Objective To evaluate peritoneal transport of fluid and solutes in continuous ambulatory peritoneal dialysis (CAPD) patients using amino acid (AA)-based versus glucose-based dialysis solutions. Methods Using iodine-labeled human serum albumin (125I-HSA) as intraperitoneal volume marker, peritoneal transport was investigated in a group of 20 clinically stable patients (11 females and 9 men, age 53 ± 15 years) on CAPD for 15 – 101 months. Two paired 4-hour dwells, one with 1.36% glucose and one with 1.1% AA dialysis solution, were performed in each patient. Intraperitoneal dialysate volume, fluid absorption rate, and diffusive mass transport coefficients (KBD) and sieving coefficients (S) for glucose, creatinine, urea, potassium, and total protein were estimated for each dwell study. Dwell studies with AA solution were used to estimate KBD values for individual AAs. Results Intraperitoneal dialysate volume was higher for AA solution in comparison with glucose solution due to the higher osmolality of the AA solution. No statistically significant difference was found for KBD or S for creatinine, urea, potassium, or total protein in the dwell studies with either solution, whereas KBD for glucose was higher with AA than with glucose solution. Mean values of KBD of AA were similar but with high standard deviation, reflecting inter-individual variations in peritoneal transport rate. Conclusion Our results indicate that the AA peritoneal transport rate is strongly dependent on transport characteristics of the individual peritoneal membrane.

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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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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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Prevention and Treatment of Catheter-Related Infections in Children

Peritoneal Dialysis International ◽

10.1177/089686088700700110 ◽

1987 ◽

Vol 7 (1) ◽

pp. 34-36 ◽

Cited By ~ 11

Author(s):

Bradley A. Warady ◽

Mary Anne Jackson ◽

Joan Millspaugh ◽

Rose Marie Miller ◽

Douglas M. Ford ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Povidone Iodine ◽

Patient Treatment ◽

Chronic Peritoneal Dialysis ◽

Exit Site ◽

Tunnel Infection ◽

Significant Difference ◽

Prevention And Treatment ◽

Age Range

There is no standardized approach to exit site care and the treatment of catheter-related infections. In this study 32 children (age range 1 month -15 years) receiving chronic peritoneal dialysis received an exit-site care regimen using either soap or Povidone-iodine as the primary antiseptic. Therapy of exit-site and tunnel infections consisted of either intravenous Vancomycin (15 mg/kg initially, then 8.5 mg/kg every four days for three doses) or a combination of oral Dicloxacillin (50 mg/kg/day) and oral Rifampin (20 mg/kg/day) for 14 days. In all, there were 48 catheter related infections in 270 patienttreatment months (one case per 5.6 patient treatment months). There was no significant difference in the frequency of infection between the two antiseptic groups. Antibiotics eradicated the infection in all but one patient and in none of these patients did peritonitis complicate an exitsite/tunnel infection.

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N-Acetylglucosamine Changes Permeability of Peritoneum during Chronic Peritoneal Dialysis in Rats

Peritoneal Dialysis International ◽

10.1177/089686089801800212 ◽

1998 ◽

Vol 18 (2) ◽

pp. 217-224 ◽

Cited By ~ 17

Author(s):

George Wu ◽

Katarzyna Wieczorowska Tobis ◽

Alicja Polubinska ◽

Katarzyna Korybalska ◽

Violetta Filas ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Blood Cell ◽

Cell Count ◽

Total Protein ◽

Glucose Solution ◽

Chronic Peritoneal Dialysis ◽

Dialysis Fluid ◽

Blood Cell Count ◽

Dialysis Solution ◽

Peritoneal Permeability

Objective To evaluate the effect of supplementation of dialysis fluid with N-acetylglucosamine (NAG) on the permeability of peritoneum during chronic peritoneal dialysis in rats. Design Experiments were performed on rats with surgically implanted peritoneal catheters. Dialysis solution [DianeaI1.5% (Baxter, Deerfield, IL, U.S.A.) supplemented with either NAG 50 mmol/L or glucose 50 mmol/L (control)] was infused intraperitoneally twice, every day, for 8 weeks. Peritoneal equilibration tests (PET) were performed in all animals at the beginning of the study and after 8 weeks of dialysis. Additionally, at the end of each week, dialysis solution infused in the morning was drained after 4 hours of intraperitoneal dwell. White blood cell count, creatinine, and total protein concentrations were measured in the effluent dialysate. After 8 weeks of dialysis, the morphology of the peritoneum was studied. Results In rats exposed to dialysis fluid supplemented with NAG, peritoneal permeability to creatinine and proteins was reduced when compared to animals dialyzed with glucose solution. In NAG treated animals, staining with alcian blue for polyanions in the peritoneal interstitium was significantly stronger than in rats dialyzed with glucose solution. Conclusions Chronic peritoneal dialysis with dialysis solution supplemented with N-acetylglucosamine causes accumulation of glycosaminoglycans in the peritoneal interstitium, which results in a change of peritoneal permeability.

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

Peritoneal Dialysis International ◽

10.1177/089686089601601s115 ◽

1996 ◽

Vol 16 (1_suppl) ◽

pp. 557-561 ◽

Cited By ~ 27

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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Acute Systemic Inflammation is Associated with an Increase in Peritoneal Solute Transport Rate in Chronic Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080402400621 ◽

2004 ◽

Vol 24 (6) ◽

pp. 597-600 ◽

Cited By ~ 9

Author(s):

Soon Bae Kim ◽

Jai Won Chang ◽

Sang Koo Lee ◽

Jung Sik Park

Keyword(s):

Peritoneal Dialysis ◽

Solute Transport ◽

Systemic Inflammation ◽

Acute Inflammation ◽

Transport Rate ◽

Temporary Increase ◽

Chronic Peritoneal Dialysis ◽

Hs Crp ◽

Inflammation Group ◽

Peritoneal Solute Transport Rate

Background This study was performed to evaluate the effects of acute systemic inflammation on peritoneal solute transport rate (PSTR) in chronic peritoneal dialysis (CPD) patients. Methods A baseline standard peritoneal equilibration test (PET) was performed on each patient every 6 months, and blood concentration of high-sensitivity C-reactive protein (hs-CRP) was assayed every 2 months in our peritoneal dialysis clinic. Acute systemic inflammation was defined as a greater than 10-fold increase in hs-CRP concentration compared with baseline value, in the absence of peritonitis, and returning to baseline level in 2 months. In patients with acute systemic inflammation, PET and hs-CRP concentration assays were performed during inflammation and after recovery. Ten patients with acute systemic inflammation were enrolled in the inflammation group and 42 other patients served as controls. Results There were no significant changes in hs-CRP and dialysate-to-plasma ratio of creatinine (D/Pcreat) in the control group during the study period. In the inflammation group, median hs-CRP levels at baseline, during acute inflammation, and at recovery were 2.3 mg/L (range 0.3 – 4.5 mg/L), 39.2 mg/L (range 15.1 – 117.4 mg/L), and 3.7 mg/L (range 0.9 – 8.9 mg/L), respectively. Median D/Pcreat increased significantly from baseline (0.64; range 0.55 – 0.98) to time of acute inflammation (0.72; range 0.60 – 0.96) ( p < 0.05). The D/Pcreat at recovery was 0.67 (range 0.52 – 0.94), which decreased significantly from time of acute inflammation ( p < 0.05). There was no correlation between changes in log (hs-CRP) and changes in D/Pcreat. Conclusion We have shown here that acute systemic inflammation is associated with a temporary increase in PSTR in CPD patients.

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Charge-Affected Transperitoneal Movement of Amino Acids in Capd

Peritoneal Dialysis International ◽

10.1177/089686089601601s15 ◽

1996 ◽

Vol 16 (1_suppl) ◽

pp. 88-90 ◽

Cited By ~ 6

Author(s):

Toshiyuki Nakao ◽

Makoto Ogura ◽

Hajime Takahashi ◽

Tomonari Okada

Keyword(s):

Amino Acids ◽

Molecular Weight ◽

Dwell Time ◽

Plasma Concentrations ◽

University Hospital ◽

Blood Samples ◽

Significant Difference ◽

Molecular Charge ◽

Solute Movement ◽

Positively Charged

Our objective was to investigate the influence of molecular charge on transperitoneal solute movement in continuous ambulatory peritoneal dialysis (CAPD). Tests of peritoneal equilibration were performed. Two liters of 2.27% or 2.5% glucose CAPD dialysate were infused and the dialysate samples were taken after 2 hr and 4 hr, and blood samples were obtained after 4-hr dwell time. Dialysate-to-plasma concentrations ratios (DIP) were calculated for creatinine (Cr) and three amino acids with almost the same molecular weight but quite different charges: glutamic acids (Glu: negatively charged), glutamine (Gin: near neutrally charged), and lysine (Lys: positively charged). The setting was a university hospital. There were 23 stable CAPD patients with a mean age of 56.5±9.5 years and a mean CAPD duration of 15.2±19.4 months. DIP ratio of Glu was much lower than those of Gin, Lys and Cr at both 2 hr and 4 hr (p < 0.01), and DIP of Lys was significantly lower than that of Gin (p < 0.01). There was no significant difference of DIP between Gin and Cr. The order of transperitoneal mobility among the three amino acids was Gin > Lys > Glu. Transperitoneal movement of solutes in CAPD is influenced by molecular charge, the movement of negatively charged solutes is most remarkably retarded in cases of amino acids.

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