The 24-hour D/P ratio is a convenient screen for identifying altered peritoneal transport rates

Peritoneal transport characteristics (PTC) may change without peritonitis, surgery, or other insults. Identifying patients with these changes is essential in adjusting the dialysis prescription to achieve optimal peritoneal dialysis on a long-term basis. Frequent standard peritoneal equilibration tests (PETs) become impractical as the population in individual programs expands. The time demands are burdensome to the nursing staff as well as to the patient. The accuracy of fast PETs is dependent upon the patient's exact adherence to the protocol steps. Utilizing the 24-hour D/P as a marker for altered PTCs has improved the efficiency of our approach to repeating standard PETs and ensuring dialysis adequacy. For adequacy studies, pooled 24-hour dialysate is routinely collected in our unit. The 24-hour D/P ratio correlates well with extrapolations from original PET data and the patient's current dwell times. Discrepancies noted between the patient's actual D/P ratio and the patient's expected D/P ratio alert the clinician to possible PTC changes.