The Personal Dialysis Capacity Test Is Superior to the Peritoneal Equilibration Test to Discriminate Inflammation as the Cause of Fast Transport Status in Peritoneal Dialysis Patients

Biesen, Wim Van; Tol, Arjan van der; Veys, Nic; Dequidt, Clement; Vijt, Denise; Lameire, Norbert; Vanholder, Raymond

doi:10.2215/cjn.00820805

Cited by 46 publications

(53 citation statements)

References 24 publications

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“…It supports and extends the observations of Heaf and Van Biesen (13,14). An independent association between Pcl and PVD was demonstrated.…”

Section: Discussionsupporting

confidence: 91%

“…Ideally, to dissect out precisely the contribution of the relative pores to this process, it is necessary to measure a series of proteins at different molecular weights, a procedure that is beyond the feasibility of large prospective long-term epidemiologic studies (in this case 10 yr). In the aforementioned studies, using the PDC test, JvL is determined using either dialysate albumin (13) or total protein, although this is not always clear (14). Using these different approaches, these studies have found correlations between their measures of smalland large-pore pathways: We found that approximately 8% of the variance in Pcl could be explained by solute transport, whereas 16 to 25% of the variance in JvL could be explained by A0/␦x in the PDC studies (13,14).…”

Section: Discussionmentioning

confidence: 89%

“…In the aforementioned studies, using the PDC test, JvL is determined using either dialysate albumin (13) or total protein, although this is not always clear (14). Using these different approaches, these studies have found correlations between their measures of smalland large-pore pathways: We found that approximately 8% of the variance in Pcl could be explained by solute transport, whereas 16 to 25% of the variance in JvL could be explained by A0/␦x in the PDC studies (13,14). These higher values may well represent the greater potential for mathematical coupling when using the PDC as discussed already.…”

Section: Discussionmentioning

confidence: 99%

“…In a subsequent study, Van Biesen et al (14) found that large-poor flow was associated with survival only when corrected for A0/␦x such that a higher JvL for a given membrane area decreased survival, yet interpretation of these results is also confounded by the potential for internal mathematical coupling between JvL and A0/␦x when using the PDC test, because the former is derived from the product of the pressure gradient and the ultrafiltration coefficient, LpS, and this in turn is derived from A0/␦x (12). Both of these studies found a high level of correlation between small solute transport rates (either 4-h D/Pcr or A0/␦x) and JvL.…”

mentioning

confidence: 89%

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Peritoneal Protein Clearance and not Peritoneal Membrane Transport Status Predicts Survival in a Contemporary Cohort of Peritoneal Dialysis Patients

Perl¹,

Huckvale²,

Chellar³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Fast peritoneal membrane transport status may be due to inflammation or increased peritoneal membrane surface area. We evaluated the ability of peritoneal protein clearance (Pcl) to distinguish fast peritoneal membrane transport status as a consequence of peritoneal membrane inflammation and assess its impact on patient survival.Design, setting, participants, & measurements: Patients who initiated peritoneal dialysis at our center since January 1998 and had a baseline peritoneal equilibration test, measurement of dialysis adequacy, and 24-h dialysate Pcl were included. Demography, comorbidities, and biochemical data were prospectively collected. Follow-up was until death or the end of the period studied. Multivariate regression analysis identified factors that were associated with Pcl. A Cox proportional hazards model was used to identify factors that were associated with survival.Results: A total of 192 patients (56% men, mean age 54.3 ؎ 15.3; 32% with diabetes) were included. On univariate analysis, Pcl was negatively correlated with serum albumin and positively correlated with age, dialysate/plasma creatinine ratio (D/Pcr), the presence of peripheral vascular disease, and urine volume. On multivariate analysis, serum albumin, D/Pcr, urine volume, and peripheral vascular disease remained significant. Predictors of mortality were age, comorbidity grade, and Pcl but not D/Pcr.Conclusions: In this cohort, peritoneal transport status no longer predicted survival, whereas Pcl remained a predictor. Increased large-pore protein loss may reflect the severity of underlying cardiovascular disease, portending a poor prognosis for these patients.

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“…It supports and extends the observations of Heaf and Van Biesen (13,14). An independent association between Pcl and PVD was demonstrated.…”

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 89%

See 2 more Smart Citations

Peritoneal Protein Clearance and not Peritoneal Membrane Transport Status Predicts Survival in a Contemporary Cohort of Peritoneal Dialysis Patients

Perl¹,

Huckvale²,

Chellar³

et al. 2009

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…As such, there has been criticism of using the PET to predict ultrafiltration and dialysis prescription on the basis of the results of a single exchange. This has led to the development of other programs based on the results from each peritoneal dialysis exchange (29,30).…”

Section: Discussionmentioning

confidence: 99%

Hydration Status Does Not Influence Peritoneal Equilibration Test Ultrafiltration Volumes

Davenport

Willicombe

2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: The peritoneal equilibration test (PET) was developed some 25 yr ago and has been used to help prescribe peritoneal dialysis. However, PET is affected by several factors, including diabetes and inflammation. It was speculated that extracellular fluid overload would increase PET ultrafiltration volumes, and therefore the usefulness of the PET in routine clinical practice was audited.Design, setting, participants, & measurements: Data from 211 consecutive patients attending a university teaching hospital for a standard PET who had multifrequency bioimpedance performance were analyzed to determine which factors affected net PET ultrafiltration volumes.Results: Net PET ultrafiltration volume was independent of gender, age, diabetes, residual renal function, peritoneal dialysis prescriptions (modes and dialysates), extracellular fluid volume, or C-reactive protein (CRP). There was an inverse regression with serum albumin and sodium on multiple logistical regression analysis (F ‫؍‬ 13.4, P < 0.001 and F ‫؍‬ 10.1, P ‫؍‬ 0.001, respectively) and a positive regression with 24-h net peritoneal ultrafiltration volumes (F ‫؍‬ 15.5, P < 0.001). As expected, there was a strong correlation with net sodium losses (r ‫؍‬ 0.99, P < 0001).Conclusions: It was found that PET test ultrafiltration volume in routine clinical practice was not affected by CRP, hyperglycemia, or extracellular fluid volume overload. Ultrafiltration volumes were increased in those patients with reduced serum sodium and albumin, most likely because of inflammation and protein malnutrition.

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Peritoneal Dialysis in Children

Alexander

2009

Nolph and Gokal’s Textbook of Peritoneal Dialysis

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The Personal Dialysis Capacity Test Is Superior to the Peritoneal Equilibration Test to Discriminate Inflammation as the Cause of Fast Transport Status in Peritoneal Dialysis Patients

Cited by 46 publications

References 24 publications

Peritoneal Protein Clearance and not Peritoneal Membrane Transport Status Predicts Survival in a Contemporary Cohort of Peritoneal Dialysis Patients

Peritoneal Protein Clearance and not Peritoneal Membrane Transport Status Predicts Survival in a Contemporary Cohort of Peritoneal Dialysis Patients

Hydration Status Does Not Influence Peritoneal Equilibration Test Ultrafiltration Volumes

Peritoneal Dialysis in Children

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