The Peritoneal Membrane’s Transportation Characteristics In Chronic Peritoneal Dialysis Patients At The Start Of Dialysis

Document Type : Research Paper


1 Associate Professor of Nephrology, Mashhad University of Medical Sciences, Mashhad, Iran

2 BSc in Computer Engineering, Torbat Jam Branch, Islamic Azad University, Torbat Jam, Iran.


Introduction: As evaluation of peritoneal membrane function is important in prescribing and choosing the kind of peritoneal dialysis and probability of difference in peritoneal membrane  characteristics among patients belonging to different geographical areas and different ethnic origin, also the possible impact of the type of transportation on patient survival,  we used peritoneal equilibration test (PET) to determine the kind of peritoneal membrane transportation at the start of dialysis.
Materials and Methods: Forty  CAPD (continuous ambulatory peritoneal dialysis)patients, (30 males and10 females,  with a mean age of 38 ± 14 years) attending Ghaem hospital, Mashhad, Iran, between October 2004 and October 2018, entered in to this study and underwent a 4.25% glucose, PET test.
Results: The obtained result showed that about 90% of patients were high or high average transporters. The results were completely different from  the results reported from other world’s peritoneal dialysis centers, which have reported between 35 to 55 percent of high or high average transporters among chronic peritoneal dialysis patients. Using a glucose correction factor formula, proposed by Twardowski, about thirty years ago, which only partially resolves the accuracy and precision problems, is the probable cause of this disparity.
Conclusion: In our center, about 90% of chronic peritoneal dialysis patients on CAPD, at the start of dialysis, were high or high average transporters. These results are in complete discordance with results reported in  medical literature or from other parts of the world. Using an outdated, glucose correction factor, with significant  residual error may be the source of this discrepancy.


1- Mehrotra R, Ravel V, Streja E, Kuttykrishnan S, Adams SV, Katz R, et al. Peritoneal equilibration test and patient outcomes. Clin J Am Soc Nephrol 2015; 10:1990-2001.
2- Vonesh EF, Story KO, O'Neill WT. A multinational clinical validation study of PD ADEQUEST 2.0. PD ADEQUEST international study group. Periton Dial Int 1999; 19:556-71.
3- Nolph KO, Khanna R, Prowant BF, Ryan LP, Moore HL, Nielsen MP. Peritoneal equilibration test. Periton Dial Int 1987; 7:138-48.
4- Chitalia VC, Almeida AF, Rai H, Bapat M, Chitalia KV, Acharya VN, et al. Is peritoneal dialysis adequate for hypercatabolic acute renal failure in developing countries? Kidney Int 2002; 61:747-57.
5- Fischereder M, Schröppel B, Wiese P, Fink M, Banas B, Schmidbauer S, et al. Regulation of glucose transporters in human peritoneal mesothelial cells. J Nephrol 2003; 16:103-9.
6- Rippe B. A three-pore model of peritoneal transporter. Periton Dialysis Int 1993; 13:S35-8.
7- Flessner MF. The importance of the interstitium in peritoneal Transporter. Periton Dial Int 1996; 16:S76-9.
8- Flessner MF. Peritoneal transport physiology: insights from basic research. J Am Soc Nephrol 1991; 2:122-35.
9- Krediet RT. The physiology of peritoneal solute, water, and lymphatic transport. Nolph and Gokal's textbook of peritoneal dialysis. Boston: Springer; 2009. P. 137-72.
10- Ho-dac-Pannekeet MM, Schouten N, Langendijk MJ, Hiralall JK, de Waart DR, Struijk DG, et al. Peritoneal transport characteristics with glucose polymer based dialysate. Kidney Int 1996; 50:979-86.
11- Wiggins KJ, McDonald SP, Brown FG, Rosman JB, Johnson DW. High membrane Transporter status on peritoneal dialysis is not associated with reduced survival following transfer to haemodialysis. Nephrol Dial Transplant 2007; 22(10):3005-12.
14- Correa-Rotter R, Cueto-Manzano A. The problem of the high transporter: is survival decreased? Periton Dial Int 2001; 21:S75-9.
15- 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.
16- Wu CH, Huang CC, Huang JY, Wu MS, Leu ML. High flux peritoneal membrane is a risk factor in survival of CAPD treatment. Adv Perit Dial 1996; 12:105-9.
17- Sezer S, Tutal E, Arat Z, Akçay A, Celik H, Ozdemir FN, et al. Peritoneal transporter status influence on atherosclerosis/inflammation in CAPD patients. J Ren Nutr 2005; 15:427-34.
19- Sobiecka D, Waniewski J, Weryński A, Lindholm B. Peritoneal fluid transport in CAPD patients with different transport rates of small solutes. Perit Dial Int 2004; 24:240-51.
20- Mujais S, Nolph K, Gokal R, Blake P, Burkart J, Coles G, et al. international society for peritoneal dialysis ad hoc committee on ultrafiltration management in peritoneal dialysis: evaluation and management of ultrafiltration problems in peritoneal dialysis. Perit Dial Int 2000; 20:S5-21.
21- Mehrotra R, Ravel V, Streja E, Kuttykrishnan S, Adams SV, Katz R, et al. Peritoneal equilibration test and patient outcomes. Clin J Am Soc Nephrol 2015; 10:1990-2001.
22- Farrell SC, Bailey MP. Measurement of creatinine in peritoneal dialysis fluid. Ann Clin Biochem 1991; 28:624-5.
23- Perl J, Bargman JM, Kulasingam V, Yip PM. Modification of the glucose correction factor by peritoneal dialysis solution type in the peritoneal equilibration test. Periton Dial Int 2010; 30:647-50.
24- Avellan-Boza M, Hernández F, Ramos-Esquivel A. Peritoneal equilibration test in Costa Rica: discrepancies from other populations. Int J Nephrol 2014; 2014:326163.
25- Twardowski ZJ. Clinical value of standardized equilibration tests in CAPD patients. Blood Purif 1989; 7:95-108.
26- Da Rin G, Amici G, Virga G, Bardin C, Calzavara P, Bocci C. Correction of glucose concentration interference on Jaffé kinetic creatinine assay in peritoneal dialysis. Am J Nephrol 1995; 15:480-7.