title: Two-in-one protocol: simultaneous small-pore and ultrasmall-pore peritoneal transport quantification.
abstract: BACKGROUND
  Reduced free water transport (FWT) through ultrasmall pores contributes to net ultrafiltration failure (UFF) and should be seen as a sign of more severe functional deterioration of the peritoneal membrane. The modified peritoneal equilibration test (PET), measuring the dip in dialysate Na concentration, estimates only FWT. Our aim was to simultaneously quantify small-solute transport, FWT, and small-pore ultrafiltration (SPUF) during a single PET procedure.
  
  
  METHODS
  We performed a 4-hour, 3.86% glucose PET, with additional measurement of ultrafiltration (UF) at 60 minutes, in 70 peritoneal dialysis patients (mean age: 50 ± 16 years; 61% women; PD vintage: 26 ± 23 months). We calculated the dialysate-to-plasma ratios (D/P) of creatinine and Na at 0 and 60 minutes, and the Na dip (Dip(D/PNa60')), the delta dialysate Na 0-60 (ΔDNa(0-60)), FWT, and SPUF.
  
  
  RESULTS
  Sodium sieving (as measured by ΔDNa(0-60)) correlated strongly with the corrected Dip(D/PNa60') (r = 0.85, p < 0.0001) and the corrected FWT (r = 0.41, p = 0.005). Total UF showed better correlation with FWT than with indirect measurements of Na sieving (r = 0.46, p < 0.0001 for FWT; r = 0.360, p < 0.0001 for Dip(D/PNa60')). Corrected FWT fraction was 0.45 ± 0.16. A negative correlation was found between time on PD and both total UF and FWT (r = -0.253, p = 0.035 and r = -0.272, p = 0.023 respectively). The 11 patients (15.7%) diagnosed with UFF had lower FWT (89 mL vs 164 mL, p < 0.05) and higher D/P creatinine (0.75 vs 0.70, p < 0.05) than did the group with normal UF. The SPUF correlated positively with FWT in the normal UF group, but negatively in UFF patients (r = -0.709, p = 0.015). Among UFF patients on PD for a longer period, 44.4% had a FWT percentage below 45%.
  
  
  CONCLUSIONS
  Measurement of FWT and SPUF is feasible by simultaneous quantification during a modified 3.86% glucose PET, and FWT is a decisive parameter for detecting causes of UFF in addition to increased effective capillary surface.
authors.affiliation: Nephrology Department, Centro Hospitalar do Porto, Hospital de Santo António, and ICBAS/UP, Porto, Portugal. anabernardo@portugalmail.pt
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Bernardo
authors.forename: M Auxiliadora
authors.initials: MA
authors.lastname: Bajo
authors.forename: Olivia
authors.initials: O
authors.lastname: Santos
authors.forename: Gloria
authors.initials: G
authors.lastname: del Peso
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Carvalho
authors.forename: António
authors.initials: A
authors.lastname: Cabrita
authors.forename: Rafael
authors.initials: R
authors.lastname: Selgas
authors.forename: Anabela
authors.initials: A
authors.lastname: Rodrigues
mesh_terms: D000328:Adult; D000368:Aged; D020346:Aquaporins; D001692:Biological Transport; D003404:Creatinine / Q000032:analysis; D003430:Cross-Sectional Studies; D015314:Dialysis Solutions / Q000378:metabolism*; D005260:Female; D005947:Glucose / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D010537:Peritoneum / Q000378:metabolism*; D012964:Sodium / Q000032:analysis; D017211:Treatment Failure; D014462:Ultrafiltration; D014867:Water / Q000378:metabolism
chemical_list: D020346:Aquaporins; D015314:Dialysis Solutions; D014867:Water; D012964:Sodium; D003404:Creatinine; D005947:Glucose