| Abstract|| |
Peritoneal dialysis (PD) is a well-established modality for treatment of patients with endstage renal disease, giving excellent patient and technique survival rates. In Saudi Arabia, data collected by the Saudi Center for Organ Transplantation showed that in 2008, patients on PD accounted for a mere 4.8% of total patients on renal replacement therapy, including hemodialysis and renal transplantation. This study was conducted to identify the characteristics of membrane permeability in the Saudi population and to assess the role of various factors affecting solute transport across the peritoneal membrane. We followed up a total of 52 patients on Continuous Ambulatory Peritoneal Dialysis (CAPD) as well as Automated Peritoneal Dialysis (APD), being treated in the PD unit of the King Khalid University Hospital, Riyadh. There were 30 female and 22 male patients; 14 patients were using CAPD while 38 patients were on APD. The mean age of the patients was 50.5 years, with a range of 14-86 years. The average body mass index (BMI) was 27.1 kg/m 2 and the mean body surface area (BSA) of the study patients was 1.71 m 2 . A standardized PET test was performed on all patients, 4-6 weeks after initiation of regular PD. The Kt/V and creatinine clearance measured 6-8 weeks after initiation of dialysis were 1.96 and 56.59 L/week, respectively. Residual renal function was assessed on the basis of daily urine output, using 24-hour urine collection. The mean serum urea concentration was 16.91 mmol/L and mean serum creatinine was 702 μmol/L. According to the Peritoneal Equiliberation Test (PET), 8% of the subjects belonged to the high trans-porter category, 44% patients belonged to the high-average transport group, 46% to the low-average category and 2% came in the low transporter category. Our study suggests that the patient characteristics and demographic parameters seen in the Saudi population are comparable to those seen in other studies from the Middle East and worldwide, including data collected from Canada, New Zealand and Mexico.
|How to cite this article:|
Al-wakeel J, Al-Ghonaim M, Al-Suwaida A, Askar A, Usama S, Feraz N, Shah IH, Memon N, Qudsi A, Sulaimani F. Peritoneal membrane characteristics in patients on peritoneal dialysis. Saudi J Kidney Dis Transpl 2011;22:49-53
|How to cite this URL:|
Al-wakeel J, Al-Ghonaim M, Al-Suwaida A, Askar A, Usama S, Feraz N, Shah IH, Memon N, Qudsi A, Sulaimani F. Peritoneal membrane characteristics in patients on peritoneal dialysis. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2019 Apr 24];22:49-53. Available from: http://www.sjkdt.org/text.asp?2011/22/1/49/74343
| Introduction|| |
Peritoneal dialysis (PD) is a well-established modality of treatment for patients with endstage renal disease (ESRD), giving excellent short-term patient and technique survival rates.  However, the potential complications, such as peritonitis or ultrafiltration failure and insufficient knowledge among patients and clinicians have led to this mode of treatment being unutilized in most parts of the world. ,, In recent years, substantial data have been gathered on the characteristics of the peritoneal membrane and on the anatomical and pathophysiological changes occurring with long-term PD.  However, there is a dearth of information available regarding characteristics of patients on PD among the Middle East and Arab population. In Saudi Arabia, data collected by the Saudi Center for Organ Transplantation showed that in 2008, PD patients accounted for a mere 4.8% of total patients undergoing renal replacement therapy, including hemodialysis and renal transplantation.
| Patients and Methods|| |
We followed a total of 52 patients on Continuous Ambulatory Peritoneal Dialysis (CAPD) as well as Automated Peritoneal Dialysis APD, being treated in the PD unit of the King Khalid University Hospital, Riyadh. There were 30 female and 22 male patients of whom 14 were using CAPD and 38 patients were on APD. In all patients, a standardized Peritoneal Equiliberation Test (PET) was carried out, as well as Kt/V and creatinine clearance were measured 4-6 weeks after initiation of dialysis and clearance studies were repeated at 3-4 month intervals, subsequently. The membrane type was defined based on the 4-hour dialysate to plasma creatinine ratio (4-hour D/P Cr) as low (D/P ratio less than 0.50), low-average (D/P ratio between 0.50 and 0.65), highaverage (D/P ratio 0.65-0.80), or high (D/P ratio greater than 0.80).
Residual renal function was measured based on 24-hour urine output. The other parameters recorded included serum urea, creatinine, calcium, phosphorus, albumin, parathyroid hormone and hemoglobin levels.
| Statistical Analysis|| |
The data were analyzed using SPSS software for statistical analysis and a P value of <0.05 was considered significant.
| Patient Characteristics|| |
There were 30 female (56.67%) and 22 male patients (43.39%). Thirty-eight patients were started on PD as primary modality of renal replacement therapy and 12 patients were shifted to PD after having problems on hemodialysis, such as vascular access failure and hypotension. Two patients were started on PD following graft failure after renal transplantation. Fourteen patients were using CAPD while 38 patients were on APD. The average body mass index (BMI) was 27.13 kg/m 2 and the mean body surface area (BSA) of the study patients was 1.71 m 2 . The mean age of the patients was 50.51 years, with five patients being less than 20 years of age, seven patients between 21 and 40 years old, 21 patients between 41 and 60 years of age and 19 patients were above 60 years. The primary causes of ESRD are shown in [Table 1].
Other causes included adult polycystic kidney disease, systemic lupus erythematosus (SLE), multiple myeloma, hyperoxaluria and IgA nephropathy.
| Results|| |
According to the PET, 8% of the subjects belonged to the high transporter category, 44% belonged to the high-average transport group, 46% to the low-average category and 2% belonged to the low transporter category. The distribution of PET test results is shown in [Table 2].
|Table 2: Peritoneal membrane permeability characteristics in the study patients.|
Click here to view
The average weight gain in the patients was 4.203 kg (1.2-9.9 ± 2.987). The mean urine output was 610 ± 798 mL/day. The average total Kt/V was 1.96 ± 1.24 and total creatinine clearance was 56.59 ± 24.85 L/week. The mean hemoglobin in these patients was 11.02 ± 1.8 g/dL. The average dose of erythropoietin was 7031.5 IU/week, and the average daily glucose exposure was 170.67 g/day. Of the 52 patients studied, 31 were using icodextrin, either as night cycle in CAPD or as long day dwells in Continuous Cycler Peritoneal Dialysis (CCPD) patients. The other parameters are shown in [Table 3].
| Discussion|| |
Currently, PD is used in approximately 15% of the dialysis population worldwide.  However, the disparities in the prevalence of patients on PD therapy in various countries could be explained either by financial incentives in favor of hemodialysis or by a lack of patient education regarding the various dialysis modalities.  In recent years, we have seen a large number of studies which show links between peritoneal membrane characteristics, mode of dialysis and patient as well as technique survival in the long term. , Consequently, a better understanding of membrane characteristics and its effect on modality of dialysis in our local population is vital for success of any PD program. The patient characteristics and demographic parameters seen in this population are comparable to those seen in other studies from the Middle East and worldwide. ,,,,,,
A study on 54 adult prevalent PD patients at the Kingston General Hospital, Kingston, Ontario, Canada, showed that on the basis of peritoneal transport, there were zero low transporters, 17 low-average (31%), 22 high-average (41%) and 15 (28%) high transporters. 
The study group at the Department of Nephrology and Mineral Metabolism, Mexico DF, Mexico, reported on 55 patients (29 males, 26 females). The distribution of patients according to their peritoneal transport rate was as follows: 13 patients (24%) were classified as having low peritoneal transport, 16 (29%) as lowaverage transporters, 19 (34%) as high-average transporters, and seven patients (13%) had a high peritoneal transport rate. 
A total of 918 patients were reported from the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry. They included 153 patients (16.7%) who were high transporters, 472 (51.4%) were high-average transporters, 257 (28.0%) were low-average transporters and 36 (3.9%) were low transporters. 
Most of the patients in each study fell in the low-average and high-average transporter categories, followed by high transporters and the least common group were the low transporters. The data from Mexico show a higher percentage of low transporter membrane type, whereas the data from Canada show a higher number of patients in the high transport category, as compared to data from other populations [Figure 1]. This could be explained by the preexisting renal disease, co-morbidities and time on PD, as well as racial differences. However, more studies with a larger patient population and longer follow-up are needed to fully understand the membrane physiology and transport kinetics for Saudi and Middle East population on PD21. As the membrane type and transport kinetics play a major role in determining the mode of dialysis and patient outcome, this knowledge is essential in improving patient and technique survival.
|Figure 1: Comparison of peritoneal membrane character in different study populations.|
Click here to view
| References|| |
|1.||Gokal R, Mallick NP. Peritoneal dialysis. Lancet 1999;353:823-8. |
|2.||Goovaerts T, Jadoul M, Goffin E. Influence of a pre-dialysis education program (PDEP) on the mode of renal replacement therapy. Nephrol Dial Transplant 2005;20:1842-7. |
|3.||Troidle L, Kliger A, Finkelstein F. Barriers to utilization of chronic peritoneal dialysis in net-work #1, New England. Perit Dial Int 2006; 26:452-7. |
|4.||United States Renal Data System. Available at http://www.usrds.org/adr.htm , accessed February 10, 2006 |
|5.||Mehrotra R, Kermah D, Fried L, et al. Chronic peritoneal dialysis in the United States: dec-lining utilization despite improving outcomes. J Am Soc Nephrol 2007;18:2781-8. |
|6.||Nakamoto H, Kawaguchi Y, Suzuki H. Is tech-nique survival on peritoneal dialysis better in Japan? Perit Dial Int 2006;26:136-43. |
|7.||Davies SJ, Phillips L, Griffiths AM, Russell LH, Naish PF, Russell GI. What really happens to people on long-term peritoneal dialysis? Kidney Int 1998;54:2207-17. |
|8.||Rumpsfeld M, McDonald SP, Purdie DM, Collins J, Johnson DW. Predictors of baseline peritoneal transport status in Australian and New Zealand peritoneal dialysis patients. Am J Kidney Dis 2004;43:492-501. |
|9.||Al-Hilali N, Al-Humoud H, Nampoory M, Ninan A, Johny K. Outcome and Survival in different peritoneal dialysis modalities. Ther Apher Dial 2007;11(2):101-6. |
|10.||Al-Hilali N, Nampoory MR, Ninan TV, Ali JH, Gawish A, Johny KV. Viability of home peri-toneal dialysis: Experience with 100 patients from Arab population. Perit Dial Int 2003; 23(Suppl2):165-9. |
|11.||Selgas R, Bajo MA, Cirugeda A, et al. Ultra-filtration and small solute transport at initiation of PD: questioning the paradigm of peritoneal function. Perit Dial Int 2005;25:68-76. |
|12.||Al-Hilali N, Mangalathillam RN, Ninan N, et al. Incidence, prevalence and treatment moda-lities of ESRD in 10 Middle East countries. Ethn Dis 2006;16:2. |
|13.||Saudi Center for Organ Transplantation, Annual Report 2007 Available from: http://www.scot. org.sa. |
|14.||PDServe Asia Pacific 2005-Hong Kong Email:PDServe.HK@fmc-asia.com |
|15.||Pilkey RM, Morton AR, Iliescu EA. Inflam-mation, Peritoneal Transport, and Response to Erythropoietin in Peritoneal Dialysis Patients Queen′s University and Kingston General Hospital, Kingston, Ontario, Canada |
|16.||Diaz-Alvarenga A, Abasta-Jimenez M, Bravo B, Gamba G, Correa-Rotter R. Serum albumin and body surface area are the strongest pre-dictors of the peritoneal transport type. Perit Dial Int 2004;23:75-89. |
|17.||Wiggins KJ, McDonald SP, Brown FG, Rosman JB, Johnson DW. High membrane transport status on peritoneal dialysis is not associated with reduced survival following transfer to hemodialysis. Nephrol Dial Transpl 2007;22(10):3005-12. |
Nephrology Division, Department of Medicine (38), King Khalid University Hospital, P.O. Box 2925, Riyadh 11461
[Table 1], [Table 2], [Table 3]