Peritoneal equilibration test in our CAPD patients: A retrospective analysis

Muthuselvi1, Vinodhini1, Balasubramaniyam2.

1PD technologists, Kauvery Hospital, Alwarpet. Chennai

2Nephrologist. Kauvery Hospital, Alwarpet. Chennai

Background

Peritoneal Equilibration Test (PET) is a semi-quantitative test to assess the transport character of the peritoneal membrane transport (1). Contrary to Hemodialysis (HD) where the purification of blood happens outside the patient’s body, in Peritoneal Dialysis (PD) purification happens inside the patient’s peritoneal cavity.  In HD, various components like the type of dialysis membrane, its surface area, permeability aspects of the membrane, blood flow, and dialysate flow are modifiable according to the need. However, in PD most of these factors are non-modifiable. Only the dialysate volume and the dwell time, number of exchanges are modifiable.

The peritoneal membrane plays a crucial role in determining the transport of solutes between the blood in the peritoneal capillaries and the dialysate in the peritoneal cavity. PET determines if a patient’s peritoneal membrane transports these solutes faster or slower. This determines the dwell time (the duration the fluid stays in the peritoneal cavity for optimal diffusion of solutes). Faster transporters need shorter dwell and slower transporters need longer dwell times.

Aim: To retrospectively study, the peritoneal membrane transport characteristics in our CAPD patients.

Materials and Methods: patients who were initiated on PD in our center undergo PET test as per the protocol. The peritoneal dialysis fluid is kept in the abdomen for 4 hours after an overnight dwell. The blood and the dialysate fluid is tested for sugar and creatinine at 0, 2 and 4 TH hour to decide the rate of transfer of the solutes. Patients were divided into High (H) High Average (HA) Low Average (LA) and Low (L) based on the speed at which transfer happens across the membrane.

The rate of transfer of creatinine is tested by D2/P2 and D4/P4 where D2 / D4 are the dialysate creatinine at 2 and 4 hours and P2 /P4 are plasma creatinine at 2nd and 4th hour. Similarly, D0, D2 and D4 are dialysate sugars at zero, 2 and 4s hour.  The PET (1) graph developed by Zybulet Twardowski is used universally to define the transporter status based on the D/P creatinine and d/d0 glucose.

Fig (1): PET graph

Results

Total number of patients included in this study is 60 of which the gender ratio is 46: 14 (Men: women). Basic disease was Diabetic Nephropathy in 39 patients and Non-diabetic renal disease in 21.

15 patients had significant CAD. Most of the patients were above 60 years (50 /60) and 10 patients were less than 60 years of age. Age group < 50 years -2 patients, 50-60 years 8 patients, 60-70 years 17 patients and above 70 years 19 patients.

The PET characteristics revealed HN

Fig (2): PET characteristics

Discussion

In spite of close to 750 hospitals in India perform peritoneal dialysis, the peritoneal membrane characteristics are not widely studied. The transport characteristics vary across the world. Study from North of India, by Prof. Agarwal et al (2) reported more High and High Average transporters. Earlier we reported from a different center our 141 patient analysis that revealed (3) more Low average transporters (66.26%) followed by High Average transporters (19.66%). A Study from Nizam by Prof.Ram et al (4) revealed similar results with most patients in Low Average followed by High Average transporters.

In this study of 60 patients, we have almost equal numbers of Low Average and High Average transporters. PET is a mandatory investigation that is essential to know the peritoneal transport characteristics of patients towards giving a proper dialysis prescription.

Reference

  • Pannekeet MM, Imholz AL, Struijk DG, Koomen GC, Langedijk MJ, Schouten N, de Waart R, Hiralall J, Krediet RT . Kidney Int. 1995;48(3):866.
  • Agarwal DK, Sharma AP, Gupta A, Sharma RK, Pandey CM, Kumar R, et al. Peritoneal equilibration test in Indian patients on continuous ambulatory peritoneal dialysis: Does it affect patient outcome? Adv Perit Dial 2000; 16:148‑51.
  • Balasubramanyam R, Nirmala VR, Yogesh V, Vijayalakshmi J, Rekha. Peritoneal equilibration test profile in our CAPD patients‑A retrospective single center analysis. Indian J Perit Dial 2011;21:27‑9.
  • Ram, G. Swarnalatha, C. Shyam Sundar Rao, G. Diwakar Naidu, C. Latha Margaret, K. V. Dakshinamurty Department of Nephrology, Nizam’s Institute of Medical Sciences, Hyderabad, IndiaPeritoneal equilibration test: A single center data from India. March 2013 / Vol 23 / Issue 2

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