Objective. Continuous Ambulatory Peritoneal Dialysis (CAPD) is a kidney replacement therapy that has been recently incorporated in developing countries. We aim to establish our reference values, to compare them with the original and the Mexican population, and to associate some variables with the type of peritoneal transport. Methods. Thirty peritoneal equilibration tests (PET) were performed. The ratio for D/P creatinine and the D/D0 ratio for glucose were calculated and compared to reference values. We conducted a retrospective analysis to correlate peritoneal transporters with some predictive variables. Results. D/P creatinine ratio at 2 hours, D/D0 glucose ratio at 4 hours, and net ultrafiltrate volume (nUFV) were significantly different from those reported by Twardowski et al. The results documented in the Mexican population only coincide with our results for the D/P creatinine ratio at 4 hours. Any of the studied variables were associated with a specific type of peritoneal transport. Conclusions. Peritoneal permeability among Costa Rican CAPD patients is different from the original population described by Twardowski et al. and from other Latin-American population. This supports the theory that ethnical differences could be responsible for such variations and they validate our statement that each region should possess value references of their own. 1. Introduction In Costa Rica, continuous ambulatory peritoneal dialysis (CAPD) was introduced in the late eighties, initially with few patients as a short-term renal replacement therapy. Currently, social security covers around one hundred fifty adult patients (2/3 of which are men) distributed in four main hospitals around the country. Patients undergoing CAPD exhibit a wide variability in the peritoneal transport of solutes and fluids. Measuring the characteristics of peritoneal membrane transport is important for the characterization of the functional state as for the prescription of the adequate dose of dialysis therapy in an individual fashion [1, 2]. The peritoneal equilibration test (PET) is the most widely used method to characterize and classify the peritoneal transport of patients on dialysis, and their methodology was standardized by Twardowski et al. [2, 3] more than two decades ago. The PET characterizes the peritoneal membrane transport properties by determining the ratio of the creatinine concentration in the dialysate to that in the plasma after a 4？h dwell (D/Pc) and has been shown to vary considerably among individuals. However, even if the results are highly consistent in the same
References
[1]
V. La Milia, “Peritoneal transport testing,” Journal of Nephrology, vol. 23, no. 6, pp. 633–647, 2010.
[2]
O. Devuyst, P. J. Margetts, and N. Topley, “The pathophysiology of the peritoneal membrane,” Journal of the American Society of Nephrology, vol. 21, no. 7, pp. 1077–1085, 2010.
[3]
Z. J. Twardowski, K. D. Nolph, R. Khanna et al., “Peritoneal equilibration test,” Peritoneal Dialysis Bulletin, vol. 7, no. 3, pp. 138–147, 1987.
[4]
A. M. Cueto-Manzano, A. Díaz-Alvarenga, and R. Correa-Rotter, “Analysis of the peritoneal equilibration test in Mexico and factors influencing the peritoneal transport rate,” Peritoneal Dialysis International, vol. 19, no. 1, pp. 45–50, 1999.
[5]
K. S. Brimble, M. Walker, P. J. Margetts, K. K. Kundhal, and C. G. Rabbat, “Meta-analysis: peritoneal membrane transport, mortality, and technique failure in peritoneal dialysis,” Journal of the American Society of Nephrology, vol. 17, no. 9, pp. 2591–2598, 2006.
[6]
R. Dwarakanathan, H. Z. Yaakob, and H. Hadi, “Pattern of peritoneal permeability in continuous ambulatory peritoneal dialysis patients in Brunei,” Peritoneal Dialysis International, vol. 23, no. 2, pp. S11–S13, 2003.
[7]
J. Al-wakeel, M. Al-Ghonaim, A. Al-Suwaida et al., “Peritoneal membrane characteristics in patients on peritoneal dialysis,” Saudi Journal of Kidney Diseases and Transplantation, vol. 22, no. 1, pp. 49–53, 2011.
[8]
E. Rojas-Campos, H. R. Martínez-Ramírez, L. Cortés-Sanabria, et al., “The peritoneal transport type might be distinctive among different Mexican populations on CAPD,” Revista de Investigacion Clinica, vol. 60, pp. 284–291, 2008.
[9]
M. Wilkie and J. Wild, “Peritoneal equilibration testing: correcting the correction factor,” Peritoneal Dialysis International, vol. 29, no. 3, pp. 352–355, 2009.
[10]
P. G. Blake, J. M. Bargman, K. S. Brimble et al., “Clinical practice guidelines and recommendations on peritoneal dialysis adequacy 2011,” Peritoneal Dialysis International, vol. 31, no. 2, pp. 218–239, 2011.
[11]
A. R. Malik, M. A. Little, M. Henriksson, F. W. K. Tam, and E. A. Brown, “Peritonitis, peritoneal inflammation and membrane permeability: a longitudinal study of dialysate and serum MCP-1 in stable patients on peritoneal dialysis,” Journal of Nephrology, vol. 20, no. 3, pp. 340–349, 2007.
[12]
C. Ronco, M. Feriani, S. Chiaramonte et al., “Pathophysiology of ultrafiltration in peritoneal dialysis,” Peritoneal Dialysis International, vol. 10, no. 2, pp. 119–126, 1990.
[13]
E. T. Pride, J. Gustafson, A. Graham et al., “Comparison of a 2.5% and a 4.25% dextrose peritoneal equilibration test,” Peritoneal Dialysis International, vol. 22, no. 3, pp. 365–370, 2002.
[14]
A. Díaz-Alvarenga, M. Abasta-Jimenez, B. Bravo, G. Gamba, and R. Correa-Rotter, “Serum albumin and body surface area are the strongest predictors of the peritoneal transport type,” Advances in Peritoneal Dialysis, vol. 10, pp. 47–51, 1994.
[15]
A. H. Tzamaloukas, G. H. Murata, B. Piraino et al., “The relation between body size and normalized small solute clearances in continuous ambulatory peritoneal dialysis,” Journal of the American Society of Nephrology, vol. 10, no. 7, pp. 1575–1581, 1999.
[16]
G. Gillerot, E. Goffin, C. Michel et al., “Genetic and clinical factors influence the baseline permeability of the peritoneal membrane,” Kidney International, vol. 67, no. 6, pp. 2477–2487, 2005.
[17]
D. N. Churchill, K. E. Thorpe, K. D. Nolph, P. R. Keshaviah, D. G. Oreopoulos, and D. Pagé, “Increased peritoneal membrane transport is associated with decreased patient and technique survival for continuous peritoneal dialysis patients,” Journal of the American Society of Nephrology, vol. 9, no. 7, pp. 1285–1292, 1998.
