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The peritoneal equilibration test in children
D F Geary1, E A Harvey, J H MacMillan
1Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
The peritoneal equilibration test (PET) helps assess solute transport in children. Most children exhibit high or high-average peritoneal permeability when compared to adult standards.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Peritoneal Dialysis
Background:
- The Peritoneal Equilibration Test (PET) is a standard method for assessing solute transport in adults.
- Adult peritoneal permeability is categorized into four classes: high, high average, low average, and low.
- Pediatric data on peritoneal transport using PET is limited.
Purpose of the Study:
- To evaluate the feasibility and findings of the Peritoneal Equilibration Test (PET) in a pediatric population.
- To assess peritoneal solute transport and classify permeability in children using adult PET criteria.
- To identify predictors of ultrafiltration in children undergoing peritoneal dialysis.
Main Methods:
- A Peritoneal Equilibration Test (PET) was conducted on 32 children (aged 0.8-17.8 years).
- Standard PET protocol with a dwell volume of 32 +/- 5 ml/kg using 2.5% dialysate was employed.
- Dialysate-to-plasma (D/P) ratios for creatinine and urea, and dialysate glucose to initial dialysate glucose ratios (D/Do) were measured at 2 and 4 hours.
Main Results:
- Age and 2-hour D/Do glucose values were significant predictors of ultrafiltration in children.
- Net ultrafiltration after 4 hours could be predicted in 75% of children older than 9.3 years or with a 2-hour D/Do glucose > 0.45.
- Mean 4-hour D/Do glucose was 0.31 +/- 0.17 and mean 4-hour D/P creatinine was 0.71 +/- 0.12.
- At least 70% of children were classified as having high or high-average peritoneal permeability based on adult standards.
Conclusions:
- The PET is applicable to children, providing valuable insights into peritoneal transport.
- Pediatric patients often demonstrate higher peritoneal permeability compared to adult classifications.
- Age and glucose absorption are key factors influencing ultrafiltration in pediatric peritoneal dialysis.
Abstract:
The peritoneal equilibration test (PET) has been recommended in adults as a standardized means of estimating solute transport. Based on results of the PET, adult peritoneal permeability has been classified as high, high average, low average, and low. We performed a PET on 32 children aged 0.8 to 17.8 years (mean 9.3) using a dwell volume of 32 +/- 5 ml/kg of 2.5% dialysate. Dialysate to plasma (D/P) ratios for creatinine, urea, and sodium were calculated at two and four hours as were the ratios of dialysate glucose at two and four hours to the dialysate glucose at time 0 (D/Do). Stepwise logistic regression identified only the patients' age and D/Do glucose values at two hours as significant predictors of ultrafiltration. Net ultrafiltration after a four hour dwell could be predicted for 75% of children above 9.3 years, or whose D/Do glucose value at two hours was greater than 0.45. The mean and standard deviation values for D/Do glucose and D/P creatinine at four hours were 0.31 +/- 0.17 and 0.71 +/- 0.12, respectively. When children are characterized according to adult standards, at least 70% fall into the high or high average permeability categories.