Peritoneal Membrane Evaluation in Routine Clinical Practice

Rodrigues, Anabela; Silva, Sandra; Bravo, Fernanda; Oliveira, José Carlos; Fonseca, Isabel; Cabrita, António; Krediet, Raymond T.

doi:10.1159/000113009

Cited by 11 publications

(9 citation statements)

References 44 publications

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“…The PET is best described as a qualitative test; it is a helpful tool for determining appropriate PD regimens according to the solute clearance and fluid removal in individual patients and in determining the differential diagnosis of ultrafiltration failure (Twardowski et al . 1987; Rodriquez et al . 2007).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Fast Peritoneal Equilibrium Test With the Standard Method: A Pilot Study

Kazancıoğlu

Topcuoglu

Kiricimli³

et al. 2012

Journal of Renal Care

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SUMMARY Standard peritoneal equilibrium test (PET) is an implementation that requires hard work for peritoneal dialysis (PD) staff. We analysed the efficacy of the fast PET and compared its results with standard PET. Forty‐nine patients on PD therapy were included in the study. For standard PET, glucose, urea and creatinine values of dialysate were analysed at zeroth, second and fourth hours, and the patient's serum glucose, urea and creatinine values were analysed at second hour. In the fast PET, urea, glucose and creatinine values in plasma and dialysate were analysed at the fourth hour only. The results of both methods were compared with Pearson correlation and kappa tests. According to the standard PET, low transport in five patients, low‐average transport in 17 patients, high‐average transport in 23 patients and high transport types in four patients were identified. Fast PET results were similar in 46 (94%) patients (r = 0.77, p = 0.0001). Kappa (κw) analysis of results of both PETs was also statistically significant (p = 0.0001). This study showed that the peritoneal transport type may be determined more easily, practically and faster.

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Section: Discussionmentioning

confidence: 99%

Comparison of Fast Peritoneal Equilibrium Test With the Standard Method: A Pilot Study

Kazancıoğlu

Topcuoglu

Kiricimli³

et al. 2012

Journal of Renal Care

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“…To correct the calculations for diffusive sodium transport, the MTAC Cr estimated using the simplified Garred formula [following the methodology previously published by the Krediet group (16)], was also used by Asghar and Davies (22) to investigate peritoneal fluid pathways. Although the simplified Garred model may be less accurate than the Waniewski model, the good correlation between these two models allows for the use of the former model in routine clinical evaluation (11). However, we suggest that peritoneal transport quantification can rely on a two-in-one protocol of 4-hour PET that simultaneously provides information on D/P creatinine (at 4 hours) and 60-minute FWT quantification, avoiding correction formulas and indirect estimates of sodium sieving that have been found to be less discriminative.…”

Section: Two-in-one Peritoneal Equilibration Testmentioning

confidence: 99%

Two-in-One Protocol: Simultaneous Small-Pore and Ultrasmall-Pore Peritoneal Transport Quantification

et al. 2012

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BackgroundReduced free water transport (FWT) through ultrasmall pores contributes to net ultrafiltration failure (UFF) and should be seen as a sign of more severe functional deterioration of the peritoneal membrane. The modified peritoneal equilibration test (PET), measuring the dip in dialysate Na concentration, estimates only FWT. Our aim was to simultaneously quantify small-solute transport, FWT, and small-pore ultrafiltration (SPUF) during a single PET procedure.MethodsWe performed a 4-hour, 3.86% glucose PET, with additional measurement of ultrafiltration (UF) at 60 minutes, in 70 peritoneal dialysis patients (mean age: 50 ± 16 years; 61% women; PD vintage: 26 ± 23 months). We calculated the dialysate-to-plasma ratios (D/P) of creatinine and Na at 0 and 60 minutes, and the Na dip (DipD/PNa60,), the delta dialysate Na 0–60 (ΔDNa0–60), FWT, and SPUF.ResultsSodium sieving (as measured by ΔDNa0–60) correlated strongly with the corrected DipD/PNa60, ( r = 0.85, p < 0.0001) and the corrected FWT ( r = 0.41, p = 0.005). Total UF showed better correlation with FWT than with indirect measurements of Na sieving ( r = 0.46, p < 0.0001 for FWT; r = 0.360, p < 0.0001 for DipD/PNa60,). Corrected FWT fraction was 0.45 ± 0.16. A negative correlation was found between time on PD and both total UF and FWT ( r = -0.253, p = 0.035 and r = -0.272, p = 0.023 respectively). The 11 patients (15.7%) diagnosed with UFF had lower FWT (89 mL vs 164 mL, p < 0.05) and higher D/P creatinine (0.75 vs 0.70, p < 0.05) than did the group with normal UF. The SPUF correlated positively with FWT in the normal UF group, but negatively in UFF patients ( r = -0.709, p = 0.015). Among UFF patients on PD for a longer period, 44.4% had a FWT percentage below 45%.ConclusionsMeasurement of FWT and SPUF is feasible by simultaneous quantification during a modified 3.86% glucose PET, and FWT is a decisive parameter for detecting causes of UFF in addition to increased effective capillary surface.

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“…The risk phase with clinical impact may be documented by the late increasing side of the U-shaped curve, with decreasing mesothelial cell mass as a marker of structural changes that go along with UFF and sodium sieving compromise. Again we highlight the importance of routine membrane monitorization also including an accessible and affordable structural marker—CA125 effluent appearance rate [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Previous Renal Replacement Therapy Time at Start of Peritoneal Dialysis Independently Impact on Peritoneal Membrane Ultrafiltration Failure

Oliveira

Rodrigues

2011

International Journal of Nephrology

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Background. Peritoneal membrane changes are induced by uraemia per se. We hypothesise that previous renal replacement therapy (RRT) time and residual renal function (RRF) at start of peritoneal dialysis impact on ultrafiltration failure (UFF). Methods. The time course of PET parameters from 123 incident patients, followed for median 26 (4–105) months, was evaluated by mixed linear model. Glucose 3.86% solutions were not used in their standard therapy. Sex, age, diabetes, previous RRT time, RRF, comorbidity score, PD modality and peritonitis episodes were investigated as possible determinants of UFF-free survival. Results. PET parameters remained stable during follow up. CA125 decreased significantly. Inherent UFF was diagnosed in 8 patients, 5 spontaneously recovering. Acquired UFF group presented type I UFF profile with compromised sodium sieving. At baseline they had lower RRF and longer previous time of RRT which remained significantly associated with UFF-free survival by Cox multivariate analysis (HR 0.648 (0.428–0.980), P = 0.04) and (HR 1.016 (1.004–1.028), P = 0.009, resp.). UFF free survival was 97%, 87% and 83% at 1, 3 and 5 years, respectively. Conclusions. Inherent UFF is often unpredictable but transitory. On the other hand baseline lower RRF and previous RRT time independently impact on ultrafiltration failure free survival. In spite of these detrimental factors generally stable long-term peritoneal transport parameters is achievable with a 5-year cumulative UFF free survival of 83%. This study adds a further argument for a PD-first policy.

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Peritoneal Membrane Evaluation in Routine Clinical Practice

Cited by 11 publications

References 44 publications

Comparison of Fast Peritoneal Equilibrium Test With the Standard Method: A Pilot Study

Comparison of Fast Peritoneal Equilibrium Test With the Standard Method: A Pilot Study

Two-in-One Protocol: Simultaneous Small-Pore and Ultrasmall-Pore Peritoneal Transport Quantification

Previous Renal Replacement Therapy Time at Start of Peritoneal Dialysis Independently Impact on Peritoneal Membrane Ultrafiltration Failure

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