The Fast Peritoneal Equilibration Test First and Second Hour Results (original) (raw)
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Objective: The aim of this study was to analyze the correlation between the peritoneal equilibration test (PET) and the dialysis adequacy and transport test (DATT) for peritoneal transport type characterization, and the degree of patients' acceptance for each test. ♦ ♦ ♦ ♦ ♦ Design: Cross-sectional, observational multicenter study. ♦ ♦ ♦ ♦ ♦ Setting: Five referral (tertiary) dialysis centers of institutional practice. ♦ ♦ ♦ ♦ ♦ Patients: The study included 107 adult continuous ambulatory peritoneal dialysis (CAPD) patients with a prescription of four exchanges of 2 L per day, irrespective of age, gender, cause of end-stage renal disease, time on dialysis, nutritional status, or residual renal function. Patients on immunosuppressive therapy and those with cancer, hepatitis B, or HIV, and those having a peritonitis episode within the previous 30 days, or three or more episodes during the previous 12 months, were excluded. ♦ ♦ ♦ ♦ ♦ Main Measures: Peritoneal transport type as classified by creatinine and urea dialysis-to-plasma (D/P) ratios by PET and DATT. ♦ ♦ ♦ ♦ ♦ Results: Correlation coefficients between D/P ratios for creatinine and urea, obtained for the PET and the DATT, were 0.73 for D/P creatinine and 0.96 for D/P urea. Patients were classified into high, high-average, low-average, and low transport categories according to the mean and standard deviation of D/P creatinine values obtained from the PET at 4 hours. These values showed excellent concordance with those generated from the DATT data (κ κ κ κ κ = 0.82, 95% confidence interval 0.67 -0.93). Nineteen percent of patients showed discordance in their category when classified according to the PET versus the DATT. Patients' acceptance was better for the DATT than for the PET, as evaluated with a questionnaire. ♦ ♦ ♦ ♦ ♦ Conclusion: The DATT is an easy, inexpensive, and reliable test to assess peritoneal transport type, and it also provides information about peritoneal clearance of solutes and ultrafiltration. The DATT has better patient acceptance than the PET. Since the DATT has only been validated for patients on a fixed CAPD daily schedule of 4 × 2 L, the results should be confined only to patients receiving such a prescription.
Comparison of peritoneal equilibration test with 2.27% and 3.86% glucose dialysis solution
PubMed, 2005
Background: The standard Peritoneal Equilibration Test (PET) uses a 2.27% glucose dialysis solution in peritoneal dialysis (PD). A more hypertonic solution (3.86%) has recently been proposed to obtain further information about ultrafiltration (UF). Aim: To compare results in terms of peritoneal solute transport (4h-dialysate-to-plasma ratio, 4h-D/P) between 2.27% and 3.86% PET. Design: 23 patients on PD were randomized to form two groups, A and B. A 2.27% dextrose 2-L exchange was used in group A, followed on the same day by a 3.86% dextrose 2-L exchange, both with a 4-hour dwell (2.27% and 3.86% PET); in group B, the same treatment was administered in reverse. 4h-D/P of urea, creatinine and sodium at time 0, 60, 120 and 240 minutes and net UF were calculated for each PET and compared. Results: No significant statistical differences were found for the usual peritoneal transport indexes, 4h-D/P of urea and creatinine, between 2.27% and 3.86% PET, which produced almost identical results. The creatinine 4h-D/P were 0.67+/-0.09 vs. 0.66+/-0.10 (p= NS) and the urea 4h-D/P 0.91+/-0.04 vs. 0.90+/-0.04 (p= NS). The sodium D/P was lower at all times during the 3.86% PET: D/P60= 0.92+/-0.05 vs. 0.88+/-0.03, D/P120= 0.91+/-0.02 vs. 0.87+/-0.03, D/P240= 0.92+/-0.02 vs. 0.88+/-0.04 (p< 0.0001). The net UF was 478 +/- 175 vs. 936 +/- 233 mL respectively (p< 0.0001). Conclusion: Our study suggests that a 3.86% PD solution could be used for PET instead of the 2.27% solution in order to assess peritoneal solute transport, as well as UF, while obtaining almost identical results as the 2.27% solution.
Bosnian Journal of Basic Medical Sciences, 2010
e aim of this study was to analyze the importance of the peritoneal equilibration test (PET) in evaluation of the peritoneal membrane tranport status in patients treated with continuous ambulatory peritoneal dialysis (CAPD). e study included adult continuous ambulatory peritoneal dialysis (CAPD) patients, male and female, mean age ± , years with a prescription of four exchanges of litres (L) per day, who underwent peritoneal equilibration test (PET). Eleven of patients were diabetics. A modifi ed PET was performed during a hours dwell using , glucose dialysis solution. e dialysate/ plasma ratio of creatinine (D/P) at the end of the procedure, and the dialysate min/ initial dialysate ratio of glucose (D/D) were calculated and used as parametar of solute transport. With the test, chategorisation of patients was possible into high (H), high-average (HA), low average (LA), and low (L) transporters. In multivariate analysis age, gender, time on dialysis, comorbid diseases, diabetes mellitus (DM), serum albumin, were concidered as independent factors infl uencing the PET. Among patients (,) were classifi ed as H transpoters, () as HA, and (,) as LA. ere were no patients in low category. Creatinine D/P at hours was not diff erent DM and non-DM patients. ere were signifi cant diff erences in gender, comorbid disease, serum albumin, D/D glucose and volume drained in hours. e high transporter group had higher proporsion of man (p<,), higher proportion of patients with comorbid diseases, lower serum albumin concentration (p<,), lower D/D glucose (p<,), and lower drained volume (p<,). e PET was en easy, inexpensive, reliable test to assess peritoneal transport type and it also provided information about peritoneal clearance of solutes and ultrafi ltration. Peritoneal transport type classifi cation was recognized not only as aid for prescription, but also as a prognostic index.
The International Journal of Artificial Organs, 2017
BackgroundSequential peritoneal equilibration test (sPET) is based on the consecutive performance of the peritoneal equilibration test (PET, 4-hour, glucose 2.27%) and the mini-PET (1-hour, glucose 3.86%), and the estimation of peritoneal transport parameters with the 2-pore model. It enables the assessment of the functional transport barrier for fluid and small solutes. The objective of this study was to check whether the estimated model parameters can serve as better and earlier indicators of the changes in the peritoneal transport characteristics than directly measured transport indices that depend on several transport processes.Methods17 patients were examined using sPET twice with the interval of about 8 months (230 ± 60 days).ResultsThere was no difference between the observational parameters measured in the 2 examinations. The indices for solute transport, but not net UF, were well correlated between the examinations. Among the estimated parameters, a significant decrease bet...
Assessing the peritoneal dialysis capacities of individual patients
Kidney International, 1995
Assessing the peritoneal dialysis capacities of individual patients. A method for measuring the peritoneal dialysis capacity (PDC) of the individual patient has been developed as an aid to treatment of patients with renal failure and peritoneal dialysis. The patient collects the data him or herself during an almost normal CAPD day using a carefully designed protocol whereby the nursing time is kept to a minimum. The three-pore model is used to describe the PDC with three physiological parameters: (1.) the 'Aiea' parameter (Ajx), which determines the diffusion of small solutes and the hydraulic conductance of the membrane (LS); (2.) the final reabsorption rate of fluid from the abdominal cavity to blood (JvAR) when the glucose gradient has dissipated; and (3.) the large pore fluid flux (of plasma, JvL), which determines the loss of protein to the PD fluid. In the adult PD population (age 60, N = 97) the normal 'Area' parameter was 23,600 cm/1.73 m2, with an SEM of 650. The JVAR was 1.49 ml/min/1.73 m2 and JvL was 0.078 ml/min/1.73 m2. The PDC parameters were reproducible and could adequately predict the concentrations of the test sQiutes as well as that of 132-microglobulin. The results in terms of clearance, 'UF volume' and nutritional consequences were presented on easily understandable graphs, whereby patient compliance was improved, These physiological parameters are highly dynamic, as evidenced by the marked increases observed during peritonitis. It seems safe to conclude that PDC is a useful tool to achieve adequate dialysis and to enhance the understanding of PD exchange. Peritoneal dialysis (PD) is an increasingly popular life-supporting therapy for patients with chronic renal failure. In contrast to the membranes used in hemodialysis, the functional characteristics of the individual PD membrane are unknown. indeed, it was recognized early that there are large differences in solute and fluid exchange between individual patients treated with continuous ambulatory peritoneal dialysis (CAPD) [1]. Moreover, the consequences of inadequate, or rather insufficient, dialysis appear gradually over a long period of time and include the reappearing uremic symptoms as well as increased morbidity and mortality. The effects appear in patients as the residual renal function declines, a phenomenon often denoted "the end of the honeymoon period." Previously, infections were the major complications of PD. However, the risk of peritonitis has been reduced in the last few years and other problems such as underdialysis are now evident. Against this background, it is not surprising that there is growing interest in methods of measuring PD exchange and providing adequate dialysis. In 1987, Twardowski et al introduced a simple peritoneal equilibration test (PET) which greatly improved our knowledge of
Chang Gung medical journal
The number of elderly people with end-stage renal disease has grown in developed countries and medical teams now face the choice of dialysis therapy in elderly patients. In the present study, we retrospectively analyzed two peritoneal dialysis (PD) patients, of different ages, who were treated at the same unit by the same PD team of doctors and nurses. Our purpose was to study peritoneal membrane changes in elderly and younger PD patients. 108 patients above 60 years of age or younger at the start of dialysis, were separated into two cohorts. Diabetic patients were excluded. Peritoneal equilibration test (PET) results taken over 4 continuous years were compared between the two groups. No significant differences were seen between the two groups in peritoneal transport (D/P Cr, D/D0 glucose) during the 4-year observation. Total Kt/V and renal creatinine clearance (Ccr) values in the 4-year period were not significantly different between the two groups. Renal Ccr values showed a longit...
Comparison of a 2.5% and a 4.25% dextrose peritoneal equilibration test
Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis
Ultrafiltration (UF) failure develops over time in some patients on peritoneal dialysis. The workup of UF failure can be difficult and the 4.25% peritoneal equilibration test (PET) has been suggested to be more useful than the 2.5% PET for the workup of UF failure. It is unknown how a 4.25% PET compares to a 2.5% PET in individual patients. To assess the differences in drain volumes and sodium sieving using a 4.25% PET compared to a 2.5% PET, and to determine whether peritoneal transport rates, in terms of dialysate-to-plasma (D/P) ratios, are comparable between the two. Pilot study with each patient serving as his or her own control. Outpatient dialysis facility of Wake Forest University Baptist Medical Center. 47 patients, all of whom had a 2.5% PET and a 4.25% PET performed within 1 week of each other. Dialysate-to-plasma ratios of urea and creatinine, dialysate total protein, and dialysate glucose compared to time zero (D/D0) at 0, 2, and 4 hours. Four-hour drain volumes and sod...
Kidney International, 2006
The peritoneal equilibration test (PET) with 3.86% glucose concentration (3.86%-PET) has been suggested to be more useful than the standard 2.27%-PET in peritoneal dialysis (PD), but no longitudinal data for 3.86%-PET are currently available. A total of 242 3.86%-PETs were performed in 95 incident PD patients, who underwent the first test during the first year of treatment and then once a year. The classical parameters of peritoneal transport, such as peritoneal ultrafiltration (UF), D/D 0 , and D/P Creat , were analyzed. In addition, the absolute dip of dialysate sodium concentration (DD Na), as an expression of sodium sieving, was studied. D/D 0 was stable, and a progressive decrease in UF was observed after the second PET, whereas D/P Creat firstly increased and then stabilized. DD Na was the only parameter showing a progressive decrease over time. On univariate analysis, D/D 0 and DD Na were found to be significantly associated with the risk of developing UF failure (risk ratio (RR) 0.987 (0.973-0.999), P ¼ 0.04, and RR 0.768 (0.624-0.933), P ¼ 0.007, respectively), but on multivariate analysis only DD Na showed an independent association with the risk of developing UF failure (RR 0.797 (0.649-0.965), P ¼ 0.020). UF, D/D 0 , and D/P Creat changed only in those patients developing UF failure, reflecting increased membrane permeability, whereas DD Na significantly decreased in all patients. The 3.86%-PET allows a more complete study of peritoneal membrane transport than the standard 2.27%-PET. DD Na shows a constant and significant reduction over time and is the only factor independently predicting the risk of developing UF failure in PD patients.