[Peritoneal equilibrium test with hypertonic exchange: practical application in a peritoneal dialysis program].

Area of Science:

• Nephrology
• Clinical Physiology
• Dialysis Technology

Context:

• The standard peritoneal equilibration test (PET) uses 2.27%/2.5% glucose and is standard for assessing peritoneal function and small solute transport.
• Hypertonic (3.86%/4.25% glucose) PET is a newer method recommended for evaluating ultrafiltration and identifying causes of ultrafiltration failure, like aquaporin dysfunction, via dialysate sodium analysis.

Purpose:

• To investigate the optimal methods for expressing dialysate sodium changes during hypertonic PET.
• To establish normal ranges for dialysate sodium concentration in hypertonic PET.
• To identify potential adverse effects of hypertonic PET in peritoneal dialysis patients.

Summary:

• Hypertonic PET was conducted on 22 patients; seven exhibited ultrafiltration failure.
• Patients with ultrafiltration failure showed higher small solute transport and dialysate sodium levels, and longer peritoneal dialysis treatment durations.
• Dialysate sodium concentration at 60 and 240 minutes correlated directly with small solute transport and inversely with ultrafiltration. Dialysate sodium at 60 minutes better distinguished ultrafiltration failure than other parameters.

Impact:

• Hypertonic PET aids in diagnosing ultrafiltration failure.
• Dialysate sodium monitoring provides additional information primarily in severe aquaporin dysfunction cases.
• Symptomatic hypotension occurred in two patients without ultrafiltration failure, indicating potential adverse effects.