Clinical evaluation of the peritoneal equilibration test: a population-based study

Abstract

A total of 143 Peritoneal Equilibration Tests (PETs) were performed in 104 CAPD patients over a period of 18 months. A normal range (95% confidence limits) was constructed from 100 tests (68 consecutive new patients, 32 routine tests on problem-free patients) using a 2-dimensional plot of solute transfer (D/Pcreat) and ultrafiltration volume. These two parameters correlated inversely (r = -0.59, P < 0.0001) allowing calculation of a regression line. In the short term (< 3 months) D/Pcreat was stable across a wide range of values (0.45-0.98) with good correlation between tests indicating reproducibility (r = 0.94, P < 0.001). Repeated tests beyond 3 months were variable, explaining changes in the clinical picture, and in the majority of cases shifts in D/Pcreat and ultrafiltration parallelled the regression line for the whole population. Six of seven (85%) of patients with mechanical problems and 14 of 15 (93%) with poor ultrafiltration had at least one abnormal test, and these two problems could be distinguished in 90% of cases by 2-dimensional plotting. In five with ultrafiltration failure, dialysate volumes were less than predicted by solute clearance, and these patients failed continuous cycling peritoneal dialysis (CCPD). In contrast, a good response to CCPD was predicted correctly in five patients with high solute clearance. In nine patients with plasma creatinine > 1250 mumol/l the PET was normal. The PET is a useful adjunct to understanding and prescribing peritoneal dialysis, particularly when repeated tests are compared to a well-defined normal population.

Comparison of Fast Peritoneal Equilibration Tests with 1.36 and 3.86% Dialysis Solutions

“…The purpose of creating and standardising a peritoneal transport test is to provide a sim ple and reliable instrument to investigate complex physiological mechanisms on the ba sis of peritoneal exchanges, quantity them and thereby attain optimum dialytic prescrip tion [1,3,7,10], In addition, the glucose con centration of dialysis solutions to be used in the test has not yet been completely standard ized [1,2,4,5,7], However, we felt we could presume univocal behavior for each patient with regard to peritoneal transport, due to the anatomo-physiological uniqueness of each person's membrane. Consequently, to check the consistency of its measurement through the various proposed rates, even when ob tained from different tests, we performed a series of sequential Fast-PETs using dialysis solutions with a low and a high glucose con centration among those commercially avail able (1.36 and 3.86%).…”

“…The final choice of solution to be used in the test depends on the clinical and diagnostic aspects which may be influenced by the PET results [1][2][3]7], Bearing this in mind, we therefore performed two Fast-PETs [6] se quentially on each patient, on the same day, using the 1.36 and 3.86% glucose concentra tions.…”

Complications of Peritoneal Dialysis

“…Diabetics may require improved blood glucose control, which will be helped by reducing the glucose prescription and using icodextrin and amino acid solutions. 11 If the UF capacity is less than 200 ml (including overfill, otherwise zero net UF) by a routine peritoneal equilibration test (PET) 12 with 2.27% glucose or less than 400 ml by a modified standard permeability analysis (SPA) 13 with 3.86% glucose, then treatment strategy is determined by transport status (4-hour dialysate to plasma creatinine ratio). It is recommended that patients undergo routine membrane function tests (PET or SPA) at 6 weeks after starting PD and then at least on an annual basis or when clinical problems with fluid management are manifested.…”

Solutes Transport Characteristics in Peritoneal Dialysis: Variations in Glucose and Insulin Serum Levels

“…[7] Patients initiating PD demonstrate diverse small solutes transport rate (SSTR) that may significantly change along treatment. [8,9] Knowledge of the SSTR allows for better individual fluid and solutes balance; several clinical tests have been used to evaluate the SSTR. The most commonly used one-the peritoneal equilibration test (PET)-computes a four-hour dwell time peritoneum to a two-hour serum creatinine ratio, and classifies the peritoneal transport as high, high-average, low-average or low.…”