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Changes in the peritoneal equilibration test in selected chronic peritoneal dialysis patients
W K Lo1, A Brendolan, B F Prowant
1Department of Internal Medicine, University of Missouri-Columbia.
Journal of the American Society of Nephrology : JASN
|January 1, 1994
Summary
Peritoneal dialysis patients showed changes in solute transport over time, with high transporters decreasing and low transporters increasing. This shift towards average transport may prevent technique failure in long-term dialysis patients.
Area of Science:
- Nephrology
- Renal Physiology
- Dialysis Technology
Background:
- Chronic peritoneal dialysis (PD) requires monitoring of solute and water transport across the peritoneal membrane.
- Peritoneal equilibration tests (PET) assess these transport characteristics, but longitudinal changes are not fully understood.
Purpose of the Study:
- To investigate longitudinal changes in peritoneal transport characteristics in patients undergoing chronic peritoneal dialysis.
- To determine if transport characteristics evolve towards an average profile over time.
Main Methods:
- Retrospective analysis of 55 patients on chronic PD with at least two PETs between 1983 and 1992.
- Categorization of patients into high (HI), high-average (HA), low-average (LA), and low (LO) transporters based on initial PET.
- Analysis of changes in dialysate to plasma creatinine ratio (D/P creatinine) and dialysate to instilled glucose ratio (D/Do) over time.
Main Results:
- High transporters showed a significant decrease in D/P creatinine and an increase in D/Do.
- Low-average and low transporters demonstrated an increase in D/P creatinine.
- Changes in D/P creatinine and D/Do were inversely correlated with initial values and with each other, indicating actual transport modification.
- No correlation was found between transport changes and peritonitis episodes.
Conclusions:
- Peritoneal transport characteristics tend to shift towards an average profile over time in chronic PD patients.
- This centripetal transport change may explain the infrequent occurrence of technique failure due to rapid transport and the prevalence of HA transporters in long-term PD.
- Understanding these dynamic transport changes is crucial for optimizing PD management.