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A preceding exchange with polyglucose versus glucose solution modifies peritoneal equilibration test results.
T Lilaj1, E Dittrich, H Puttinger
1Department of Medicine III, Division of Nephrology, University Hospital of Vienna.
Summary
The peritoneal equilibration test (PET) using icodextrin solutions shows altered peritoneal membrane transport compared to glucose solutions. This suggests icodextrin may impact PET results, requiring specific considerations for continuous ambulatory peritoneal dialysis patients.
Area of Science:
- Nephrology and Dialysis
- Peritoneal Membrane Physiology
- Renal Replacement Therapy
Background:
- The peritoneal equilibration test (PET) is crucial for assessing peritoneal membrane function in dialysis.
- Icodextrin solutions promote ultrafiltration via colloid osmosis, particularly effective with extended dwell times.
- Current guidelines suggest specific protocols for PET following icodextrin use in continuous ambulatory peritoneal dialysis (CAPD).
Purpose of the Study:
- To compare PET results after a 10-hour dwell with 7.5% icodextrin versus 1.36% glucose solutions in CAPD patients.
- To evaluate the impact of icodextrin on peritoneal membrane solute and fluid transport parameters during PET.
Main Methods:
- Fifteen CAPD patients underwent two PETs: one following a 10-hour dwell with 1.36% glucose, and another after a 10-hour dwell with 7.5% icodextrin.
- Dialysate-to-plasma (D/P) ratios for creatinine, phosphate, sodium, glucose, urea nitrogen, protein, and albumin were measured.
- A subgroup of 5 patients also had PET performed after a 2.27% glucose dwell for comparison.
Main Results:
- PET with icodextrin showed significantly higher D/P ratios for creatinine, phosphate, and sodium compared to glucose at 1-4 hours.
- The glucose absorption quotient was significantly lower after icodextrin, indicating reduced glucose transfer.
- D/P curves for creatinine, phosphate, and glucose were steeper initially with icodextrin, while urea nitrogen, protein, and albumin showed similar D/P curves.
Conclusions:
- Icodextrin solutions significantly alter peritoneal membrane transport characteristics compared to standard glucose solutions during PET.
- The findings suggest that PET performed after icodextrin dwells may not accurately reflect baseline peritoneal membrane function.
- CAPD patients using icodextrin overnight should switch to conventional glucose solutions before a scheduled PET to ensure accurate assessment.