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Evaluation of the peritoneal equilibration test in children on chronic peritoneal dialysis
A Edefonti1, M Picca, R Galato
1Department of Pediatrics II, University of Milano, Italy.
Insights
The peritoneal equilibration test (PET), adapted for children undergoing nightly intermittent peritoneal dialysis (NIPD), provides reliable and reproducible results for assessing peritoneal transport. This study validates a modified PET for pediatric use.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Dialysis
Background:
- The peritoneal equilibration test (PET) is crucial for adults on chronic peritoneal dialysis to determine peritoneal transport rates.
- Standardized PET studies in children are limited, hindering optimized treatment prescriptions for pediatric patients.
Purpose of the Study:
- To evaluate the reliability and reproducibility of a modified Peritoneal Equilibration Test (PET) in children undergoing nightly intermittent peritoneal dialysis (NIPD).
- To assess peritoneal transport characteristics in a pediatric cohort using the modified PET.
Main Methods:
- Twenty-six modified PETs were conducted in 16 children (mean age 10.9 years) on NIPD, following Twardowski's protocol with adjustments for pediatric body weight.
- Dialysate and blood samples were analyzed for glucose and creatinine at specific dwell times (0, 2, and 4 hours for simplified test; additional time points for standard test).
- Patients were categorized based on their peritoneal transport rates (high, high-average, low-average, low).
Main Results:
- The modified PET yielded reproducible results, with good correlation between D/P creatinine and D/D0 glucose at 4 hours (p < 0.0001).
- Patients were successfully classified into different transporter categories.
- Statistically significant differences were observed between the simplified and standard PET curves in the first hour (r = 0.66; p < 0.05).
Conclusions:
- The modified Peritoneal Equilibration Test (PET) is a reliable and reproducible method for assessing peritoneal transport in children on NIPD.
- This adapted PET protocol can aid in optimizing peritoneal dialysis prescriptions for pediatric patients.
- Further standardization may enhance comparability between simplified and standard PET protocols in children.
Abstract:
The peritoneal equilibration test (PET) is routinely performed in adults treated with chronic peritoneal dialysis to assess the peritoneal transport rate and to optimize treatment prescription. Only a few and not well-standardized studies on the PET have been reported in children. Twenty-six PET's were performed in 16 children, mean age 10.9 +/- 4.9 years, mean body weight (BW) 26.8 +/- 11.9 kg, treated with nightly intermittent peritoneal dialysis (NIPD). The PET was performed according to Twardowski. Forty mL/kg BW of 2.27% glucose solution were infused at a rate of 10 mL/kg BW every 2 minutes. In the simplified test, dialysate samples were taken at dwell times 0, 2 and 4 hours for glucose and creatinine. A blood sample was taken after a 2-hour dwell time for the same parameters. The standard PET (8 patients) consisted of dialysate samples at 0, 15, 30, 60, 120, and 240 minutes and blood samples at 0 and 240 minutes. Mean D/P ratio for corrected creatinine and D/D0 ratio for glucose at 2 hours were 51.6 +/- 11.6 and 50.4 +/- 9, respectively; at 4 hours 69.6 +/- 12 and 34.4 +/- 9.8, respectively. There was good correlation between D/P creatinine and D/D0 glucose at 4 hours (p < 0.0001). Patients were classified as high (3 cases), high-average (5), low-average (6), and low (2) transporters. A statistically significant difference was found between the curves obtained by the simplified PET and those of the standard PET in the first hour (r = 0.66; p < 0.05). In conclusion, the PET, modified for use in children, gave reliable and reproducible results.(ABSTRACT TRUNCATED AT 250 WORDS)