Peritoneal Transport Characteristics

Classification of Peritoneal Transporters

The American Journal of Kidney Diseases recommends that peritoneal transporters be classified into four main types: high, high-average, low-average, and low, based on peritoneal transport characteristics determined by the Peritoneal Equilibrium Test (PET) 1, 2
The PET should be performed when the patient is clinically stable and at least 1 month after resolving a peritonitis episode, as recommended by the American Journal of Kidney Diseases 3
The American Journal of Kidney Diseases suggests that the baseline PET should be performed between 4-8 weeks after initiating peritoneal dialysis 4
Transporters with high D/P creatinine ratio have good small solute removal but poor ultrafiltration, and may experience excessive protein losses, according to the American Journal of Kidney Diseases 2
The American Journal of Kidney Diseases states that transporters with low D/P creatinine ratio have excellent ultrafiltration but may have inadequate peritoneal creatinine clearance, especially in larger patients 1, 5

The Peritoneal Equilibrium Test (PET) is the most common and standardized method for evaluating peritoneal transport, as recommended by the American Journal of Kidney Diseases 1, 6
The PET uses a 4-hour dwell with 2.27%/2.5% dextrose solution, and a PET with 3.86%/4.25% dextrose is recommended to evaluate ultrafiltration failure, according to the American Journal of Kidney Diseases 3
The Standard Permeability Analysis (SPA) evaluates the mass transfer coefficient (MTAC) of creatinine and allows for the assessment of fluid absorption and macromolecular permeability, as stated by the American Journal of Kidney Diseases 1
The Peritoneal Capacity Test (PDC) uses multiple dwells over a 24-hour period and combines the data into a mathematical model to estimate peritoneal transport characteristics, according to the American Journal of Kidney Diseases 6

The type of transporter influences the prescription of peritoneal dialysis, with high transporters benefiting from short dwells and automated peritoneal dialysis (APD), and low transporters requiring high-dose prescriptions such as continuous ambulatory peritoneal dialysis (CAPD) or continuous cycling peritoneal dialysis (CCPD), as recommended by the American Journal of Kidney Diseases 2, 5
The American Journal of Kidney Diseases suggests that low transporters may need larger infusion volumes to achieve adequate clearance 5
Over time, there may be changes in peritoneal transport characteristics, with a tendency to increase the transport rate, according to the American Journal of Kidney Diseases 4
The PET should be repeated when a change in clinical status is suspected, at least 1 month after resolving a peritonitis episode, as recommended by the American Journal of Kidney Diseases 3