Peritoneal equilibration test
- Madhukar Misra, MD, FRCP
Madhukar Misra, MD, FRCP
- Professor of Medicine
- University of Missouri School of Medicine, Columbia
- Ramesh Khanna, MD, FACP
Ramesh Khanna, MD, FACP
- Karl D Nolph Distinguished Professor of Medicine
- University of Missouri-Columbia
The peritoneal equilibration test (PET) is a semiquantitative assessment of peritoneal membrane transport function in patients on peritoneal dialysis [1,2]. The solute transport rates are assessed by the rates of their equilibration between the peritoneal capillary blood and dialysate. The ratio of solute concentrations in dialysate and plasma (D/P ratio) at specific times (t) during the dwell signifies the extent of solute equilibration. This ratio can be determined for any solute that is transported from the capillary blood to the dialysate. Creatinine, urea, electrolytes, phosphate, and proteins are the commonly tested solutes for clinical use.
Since glucose is absorbed from the dialysate to blood and very quickly metabolized, a conventional D/P ratio for glucose is meaningless. Instead, the fraction of glucose absorbed from the dialysate at specific times can be determined by the ratio of dialysate glucose concentrations at specific times (t) to the initial level in the dialysis solution (Dt/D0). The PET also helps measure ultrafiltration and residual volumes [3,4].
An overview of the peritoneal equilibration test is presented here. A detailed analysis of the utility of this examination in evaluating patients with less than adequate clearances or ultrafiltration is presented separately. (See "Problems with solute clearance and ultrafiltration in continuous peritoneal dialysis".)
ELEMENTS OF THE PERITONEAL EQUILIBRATION TEST
The PET is a highly reproducible procedure consisting of a standardized four-hour dialysis exchange with a dialysis solution . The test permits the comparison of multiple results in a patient over a long period of therapy; in addition, the results between patients within a center and between populations from different geographic locations may be compared.
The PET is standardized for the following elements :
- Pannekeet MM, Imholz AL, Struijk DG, et al. The standard peritoneal permeability analysis: a tool for the assessment of peritoneal permeability characteristics in CAPD patients. Kidney Int 1995; 48:866.
- Teitelbaum I, Burkart J. Peritoneal dialysis. Am J Kidney Dis 2003; 42:1082.
- Twardowski ZJ, Nolph KD, Khanna R, et al. Peritoneal equilibration test. Perit Dial Bull 1987; 7:138.
- Ho-dac-Pannekeet MM, Atasever B, Struijk DG, Krediet RT. Analysis of ultrafiltration failure in peritoneal dialysis patients by means of standard peritoneal permeability analysis. Perit Dial Int 1997; 17:144.
- Trivedi H, Khanna R, Lo WK, et al. Reproducibility of the peritoneal equilibration test in CAPD patients. ASAIO J 1994; 40:M892.
- Lilaj T, Vychytil A, Schneider B, et al. Influence of the preceding exchange on peritoneal equilibration test results: a prospective study. Am J Kidney Dis 1999; 34:247.
- Lilaj T, Dittrich E, Puttinger H, et al. A preceding exchange with polyglucose versus glucose solution modifies peritoneal equilibration test results. Am J Kidney Dis 2001; 38:118.
- Twardowski ZJ, Prowant BF, Moore HL, et al. Short peritoneal equilibration test: impact of preceding dwell time. Adv Perit Dial 2003; 19:53.
- Van Overmeire L, Goffin E, Krzesinski JM, et al. Peritoneal equilibration test with conventional 'low pH/high glucose degradation product' or with biocompatible 'normal pH/low glucose degradation product' dialysates: does it matter? Nephrol Dial Transplant 2013; 28:1946.
- Perl J, Bargman JM, Kulasingam V, Yip PM. Modification of the glucose correction factor by peritoneal dialysis solution type in the peritoneal equilibration test. Perit Dial Int 2010; 30:647.
- Twardowski ZJ. The fast peritoneal equilibration test. Semin Dial 1990; 3:141.
- Johnson DW, Mudge DW, Blizzard S, et al. A comparison of peritoneal equilibration tests performed 1 and 4 weeks after PD commencement. Perit Dial Int 2004; 24:460.
- Van Biesen W, Van der Tol A, Veys N, et al. The personal dialysis capacity test is superior to the peritoneal equilibration test to discriminate inflammation as the cause of fast transport status in peritoneal dialysis patients. Clin J Am Soc Nephrol 2006; 1:269.
- Khanna R. Peritoneal inflammation and high transport status. Clin J Am Soc Nephrol 2006; 1:167.
- Rodby RA, Firanek CA, Sarpolis AL. Re-evaluation of solute transport groups using the peritoneal equilibration test. Perit Dial Int 1999; 19:438.
- Rumpsfeld M, McDonald SP, Purdie DM, et al. Predictors of baseline peritoneal transport status in Australian and New Zealand peritoneal dialysis patients. Am J Kidney Dis 2004; 43:492.
- Selgas R, Bajo MA, Cirugeda A, et al. Ultrafiltration and small solute transport at initiation of PD: questioning the paradigm of peritoneal function. Perit Dial Int 2005; 25:68.
- Prowant BF, Moore HL, Twardowski ZJ, Khanna R. Understanding discrepancies in peritoneal equilibration test results. Perit Dial Int 2010; 30:366.
- Krediet RT, Boeschoten EW, Zuyderhoudt FM, et al. Peritoneal transport characteristics of water, low-molecular weight solutes and proteins during long-term continuous ambulatory peritoneal dialysis. Perit Dial Bull 1986; 6:61.
- Hallet MD, Kush RD, Lysaght MJ, et al. The stability and kinetics of peritoneal mass transfer. In: Peritoneal Dialysis, Nolph KD (Ed), Kluwer, Dordrecht 1989. p.380.
- Passlick-Deetjen J, Chlebowski H, Koch M, et al. Evaluation of long-term changes in peritoneal membrane function. In: Peritoneal Dialysis, La Greca G, Ronco C, Feriani M, et al (Eds), Wichtig, Milan 1991. p.109.
- Raja RM, Kramer MS, Barber K. Solute transport and ultrafiltration during peritonitis in CAPD patients. ASAIO J 1984; 7:8.
- Krediet RT, Zuyderhoudt FM, Boeschoten EW, Arisz L. Alterations in the peritoneal transport of water and solutes during peritonitis in continuous ambulatory peritoneal dialysis patients. Eur J Clin Invest 1987; 17:43.
- Rubin J, McFarland S, Hellems EW, Bower JD. Peritoneal dialysis during peritonitis. Kidney Int 1981; 19:460.
- Prowant BF, Nolph KD. Clinical criteria for diagnosis of peritonitis. In: Peritoneal Dialysis, Atkins RC, Thomson NM, Farrell PC (Eds), Churchill Livingstone, Edinburgh 1981. p.257.
- Twardowski ZJ. Dialysis adequacy and new cycler techniques. In: Contemporary Issues in Nephrology, Twardowski ZJ, Nolph KD, Khanna R (Eds), Churchill Livingstone, New York 1990. Vol 22, p.67.
- Twardowski ZJ, Tully RJ, Nichols WK. Computerized tomography CT in the diagnosis of subcutaneous leak sites during continuous ambulatory peritoneal dialysis (CAPD). Perit Dial Bull 1984; 4:163.
- Wankowicz Z, Pietrzak B, Przedlacki J. Colloid peritoneoscintigraphy in complications of CAPD. Adv Perit Dial 1988; 4:138.
- Pride ET, Gustafson J, Graham A, et al. Comparison of a 2.5% and a 4.25% dextrose peritoneal equilibration test. Perit Dial Int 2002; 22:365.
- Heimbürger O, Waniewski J, Werynski A, et al. Peritoneal transport in CAPD patients with permanent loss of ultrafiltration capacity. Kidney Int 1990; 38:495.
- Miranda B, Selgas R, Celadilla O, et al. Peritoneal resting and heparinization as an effective treatment for ultrafiltration failure in patients on CAPD. Contrib Nephrol 1991; 89:199.
- Huarte-Loza E, Selgas R, Carmona AR, et al. Peritoneal membrane failure as a determinant of the CAPD future. An epidemiological, functional and pathological study. Contrib Nephrol 1987; 57:219.
- Verger C, Celicout B. Peritoneal permeability and encapsulating peritonitis. Lancet 1985; 1:986.
- Dobbie JW, Krediet RT, Twardowski ZJ, Nichols WK. A 39-year-old man with loss of ultrafiltration. Perit Dial Int 1994; 14:384.
- Mujais S, Nolph K, Gokal R, et al. Evaluation and management of ultrafiltration problems in peritoneal dialysis. International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis. Perit Dial Int 2000; 20 Suppl 4:S5.
- La Milia V, Pozzoni P, Virga G, et al. Peritoneal transport assessment by peritoneal equilibration test with 3.86% glucose: a long-term prospective evaluation. Kidney Int 2006; 69:927.
- ELEMENTS OF THE PERITONEAL EQUILIBRATION TEST
- CLINICAL APPLICATIONS
- Peritoneal membrane function classification
- Prediction of dialysis dose
- Selection of peritoneal dialysis regimen
- Long-term monitoring of membrane function
- Diagnosis of membrane injury
- Diagnosis of causes of inadequate ultrafiltration and solute clearance
- Diagnosis of early ultrafiltration failure
- Assessing the influence of systemic disease on peritoneal membrane function
- SUMMARY AND RECOMMENDATIONS