Evaluation of peritoneal membrane permeability

Total removal of fluid and solutes during peritoneal dialysis depends on both the dialysis prescription (ie, the number, length, and timing of the dwells and the volume and contents of the dialysis solution) and the permeability of the peritoneal membrane. Peritoneal membrane permeability determines the rate of solute equilibration between body fluids and the solution within the peritoneal cavity and is, therefore, a significant determinant of the solute removal rate. The relationship between fluid removal during peritoneal dialysis and the properties of the peritoneal membrane is more complex; peritoneal ultrafiltration is inversely related to the permeability of the peritoneal membrane to osmotic solutes but is directly related to the hydraulic conductivity of the peritoneal membrane. The peritoneal equilibration test (PET) is widely used as the standard method for evaluating peritoneal membrane permeability, and results from the PET can be used to determine the type of peritoneal dialysis therapy optimal for the permeability characteristics of the patient's peritoneal membrane. Simple extrapolations from the PET can only provide qualitative estimates of the dialysis dose required for various types of peritoneal dialysis. More accurate estimates of the required dialysis dose can be provided by mathematical models of peritoneal fluid and solute transport, but these models require calculation of the permeability-area product or mass transfer-area coefficient of the peritoneal membrane. Although the latter approach shows promise for improving peritoneal dialysis prescriptions, determination of the delivered dose of peritoneal dialysis can, at present, only be assessed by directly measuring total 24-hour solute and fluid removal.