Peritoneal function and assessment of reference values using a 3.86% glucose solution.
BACKGROUND
The most widely used peritoneal function test, the peritoneal equilibration test (PET), is performed with a 2.27% glucose solution. Recently, the International Society for Peritoneal Dialysis committee on ultrafiltration failure (UFF) advised performing the test with 3.86% glucose solution because it is more sensitive for detecting clinically significant UFF. Because no reference values for this test were available, we analyzed the results of standard peritoneal permeability analyses (SPAs) using 3.86% glucose.


METHODS
The tests were performed in our center on 154 clinically stable peritoneal dialysis (PD) patients that were free of peritonitis for at least 4 weeks. For the assessment of reference values, we used two approaches. In approach A, patients with UFF, defined as net ultrafiltration (UF) < 400 mL/4 hours, were excluded. In approach B, only patients within their first 2 years of PD treatment were included, regardless of net UF. Means and 95% confidence intervals (95% CI) were calculated for the transport parameters of the PET and SPA.


RESULTS
Means of normal distribution with 95% CI in approach A were as follows: for 2.0-L exchanges, mass transfer area coefficient (MTAC) for creatinine 8.8 mL/minute (4.7 - 12.7 mL/min), dialysate/plasma ratio (D/P) creatinine 0.70 (0.52 - 0.88), glucose absorption 58% (44% - 72%), dialysate240/initial dialysate ratio of glucose (Dt/D0) 0.28 (0.18- 0.38), net UF 675 mL (375 - 975 mL), and maximal dip in D/P sodium after correction for diffusion from the circulation 0.110 (0.050 - 0.164); for 1.5-L exchanges, MTAC creatinine 7.4 mL/min (3.8 - 11.0 mL/min), D/P creatinine 0.69 (0.52 - 0.86), glucose absorption 62% (52% - 72%), Dt/D0 glucose 0.25 (0.17- 0.32), net UF 551 mL (430 - 670 mL), and maximal dip D/P sodium 0.120 (0.048 - 0.166). In approach B, most of the transport values were similar; however, values for lymphatic absorption were significantly higher [1.52 mL/min (2-L) and 1.40 mL/min (1.5-L), p < 0.01] and values for the maximum dip in D/P sodium were lower [0.101 (2-L) and 0.112 (1.5-L), p > 0.05]. This was probably the result of including patients with UFF in approach B, since these parameters can be causative factors of UFF.


CONCLUSIONS
A peritoneal transport function test using 3.86% glucose provides data on various aspects of transport. This study gives normal reference values that can be used for analysis of causes of UFF.
Smit
Watske
W
Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Wa.Smit@amc.uva.nl
van Dijk
Paul
P
Langedijk
Monique J
MJ
Schouten
Natalie
N
van den Berg
Nicole
N
Struijk
Dirk G
DG
Krediet
Raymond T
RT
D000293:Adolescent; D000328:Adult; D000368:Aged; D001692:Biological Transport; D003404:Creatinine / Q000097:blood; D015314:Dialysis Solutions / Q000493:pharmacokinetics*; D005260:Female; D005947:Glucose / Q000493:pharmacokinetics*; D006801:Humans; D007552:Isotonic Solutions / Q000493:pharmacokinetics*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D010530:Peritoneal Dialysis; D010537:Peritoneum / Q000378:metabolism*; D010539:Permeability; D012016:Reference Values; D017211:Treatment Failure; D014462:Ultrafiltration
D015314:Dialysis Solutions; D007552:Isotonic Solutions; D003404:Creatinine; D005947:Glucose