Use of a modified peritoneal equilibration test to optimize solute and water clearance

Abstract

The standard peritoneal equilibration test (PET) characterizes the peritoneal transport of fluid, creatinine and urea. However, the applicability of the standard PET may be limited in patients on cycling peritoneal dialysis due to the choice of 2- and 4-h sampling times which exceed the usual dwell time of most patients on cycling peritoneal dialysis. We have performed a modified PET on seven pediatric dialysis patients in an effort to optimize dwell time to achieve maximal clearance of solutes and fluid. When compared with the standard PET, values obtained for dialysate/plasma urea and dialysate/plasma creatinine with the modified PET are significantly different. This resulted in an increased estimated creatinine clearance in five of seven and increased estimated urea clearance in six of seven patients. The modified PET is a more appropriate method for evaluation of peritoneal clearances in children as well as older patients who may require cycling peritoneal dialysis.

Clinical practice guidelines for pediatric peritoneal dialysis

“…Twardowski et al first developed the peritoneal equilibration test (PET) to characterize peritoneal transport rates [73]. There have been numerous reports to date on the use of PET in children [65,71,[74][75][76][77][78][79][80]. Warady et al addressed the lack of a standardized process and published pediatric reference data in 1996 from 95 children who underwent a standardized pediatric PET protocol [81].…”

The Optimal Approach to Peritoneal Dialysis Prescription in Children

“…The intersection time of the dialytic urea saturation and glucose desaturation curves defines the apex time (18,19). The apex time is an index for the prescrip tion of the optimum contact time in the prone posi tion to ensure, for a given IPV, optimum ultrafiltration and urea purification (20,21,22). A longer contact time reduces the ultrafiltration capacity through the loss of the crystalloid osmotic gradient as a result of dia lytic glucose being progressively reabsorbed by the patient.…”