The standard peritoneal permeability analysis: A tool for the assessment of peritoneal permeability characteristics in CAPD patients

Abstract

Peritoneal transport characteristics in CAPD patients are often assessed by the peritoneal equilibration test (PET), which uses a four hour dwell with glucose 2.27% dialysate. From the test, the dialysate/plasma ratio of creatinine (D/PCr), the dialysate/initial dialysate ratio of glucose (D/Do) and net ultrafiltration (NUF, drained minus instilled volume) are calculated. The standard peritoneal permeability analysis (SPA) is a modification and extension of the PET: glucose 1.36% dialysate is used, to which dextran 70 (1 g/liter) is added for the calculation of fluid kinetics. Mass transfer area coefficients (MTAC's) of low molecular weight solutes, clearances of proteins and the change in intraperitoneal volume (delta IPV) can be assessed. In this study the SPA was analyzed, and a comparison with the PET was made. A total number of 138 SPA's was analyzed in 86 different clinically stable patients. Normal values were calculated for both SPA and PET parameters in the same tests. Median (ranges) of comparable transport parameters from SPA and PET were: MTACCr, 10.4 ml/min (5.7 to 19.3); glucose absorption, 61% (35 to 87); delta IPV, 9.5 ml (-761 to 310); D/PCr, 0.76 (0.53 to 1.14); D/D0, 0.37 (0.13 to 0.56); NUF, -75 ml (-675 to 450). The agreement between SPA and PET was analyzed using the method of Bland and Altman. A fairly good agreement was present between NUF and delta IPV. Systematic errors were found when D/PCr and MTACCr were compared: D/P overestimated MTAC mainly in the low range, whereas in the high range values were underestimated. A similar pattern was seen for the transport parameters of glucose. In 40 patients negative net ultrafiltration was present, and possible reasons for this were assessed. In 9 patients no reason could be identified. It can be concluded that the SPA provides useful and extensive information on peritoneal transport parameters. Compared to the PET, the SPA has better discriminative power for the transport of glucose and creatinine.

Can Effluent Matrix Metalloproteinase 2 and Plasminogen Activator Inhibitor 1 be Used as Biomarkers of Peritoneal Membrane Alterations in Peritoneal Dialysis Patients?

“…The SPA is a peritoneal function assessment performed once yearly as conventional patient care at our center (20). In brief, before instillation of a 3.86% glucosebased test solution, the peritoneal cavity is rinsed with a 1.36% glucose-based dialysis solution.…”

Peritoneal Albumin and Protein Losses Do Not Predict Outcome in Peritoneal Dialysis Patients

“…Peritoneal solute and fluid transport parameters were calculated as described previously (23). Mass-transfer area coefficients (MTAC) of low molecular weight solutes were calculated according to the Waniewski model.…”

Role of Ultrafiltration in Peritoneal Dialysis: A Review

“…This selective defect in water transport has been attributed to AQP-1 channel (ultrasmall pore) dysfunction, rather than deficiency in peritoneal membrane. Type III UFF -Patients with Low-Solute Transport (D/P Creatinine < 0.5) A much less common cause for UFF is that associated with low-solute transport (D/P creatinine < 0.5) (Figure-1), which often results from conditions leading to a severe reduction in effective peritoneal membrane surface area and permeability 19 . Therefore, signs and symptoms of both fluid overload and inadequate solute removal can be present.…”