• Peritoneal transport and ultrafiltration. Nephrology 2005 Oct;10(S4):S104-7.



• Peritoneal transport and ultrafiltration. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2004 May. 10 p. [48 references]

This is the current release of the guideline.

End-stage kidney disease (ESKD)

Evaluation
Management
Treatment

Nephrology

Allied Health Personnel
Nurses
Physicians

To recommend when an initial peritoneal equilibrium test (PET) should be done and then at what frequency it should be repeated

Patients with end-stage kidney disease (ESKD) on peritoneal dialysis

Evaluation

Peritoneal equilibration test (PET) after initiation of peritoneal dialysis

Management/Treatment

1. Initiation of peritoneal dialysis
2. Repeat monitoring of PET

• Peritoneal clearance
• Residual renal function
• Mortality

Searches of Electronic Databases

Databases searched: Medline (1966 to November Week 2 2003). Medical Subject Headings (MeSH) terms and text words for peritoneal equilibrium test (PET), ultrafiltration and peritoneal dialysis were used. The search strategy was not limited by study type.

Date of search: 18 November 2003.

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Levels of Evidence

Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)

Level II: Evidence obtained from at least one properly designed RCT

Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group

Level IV: Evidence obtained from case series, either post-test or pretest/post-test

Review of Published Meta-Analyses
Systematic Review with Evidence Tables

Not stated

Expert Consensus

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Comparison with Guidelines from Other Groups
Peer Review

Recommendations of Others. Recommendations regarding peritoneal transport and ultrafiltration from the following groups were discussed: Kidney Disease Outcomes Quality Initiative, British Renal Association, Canadian Society of Nephrology, European Best Practice Guidelines, and International Society of Peritoneal Dialysis.

Definitions for the levels of evidence (I–IV) can be found at the end of the "Major Recommendations" field.

Guidelines

No recommendations possible based on Level I or II evidence

Suggestions for Clinical Care

(Suggestions are based on Level III and IV sources)

• A patient's membrane transport status should be evaluated by the standard peritoneal equilibration test (PET).
• A PET should be performed approximately 4 weeks after initiating peritoneal dialysis, but no earlier.
• PETs should be repeated at 2 years and then annually. PETs should be repeated earlier if there is clinical evidence of fluid overload with a significant decrease in ultrafiltration, hypertension or elevated serum urea levels, particularly in those patients who have had episodes of peritonitis.
• Icodextrin should not be used in the preceding exchange before a PET as it increases the dialysate:plasma (D/P) creatinine ratio.
• There is some evidence that there is a group of patients with high transporter status who have an increased mortality and an increased risk of technique failure, even with adequate small solute clearance; however, this is not conclusive.

Definitions:

Levels of Evidence

Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)

Level II: Evidence obtained from at least one properly designed RCT

Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group

Level IV: Evidence obtained from case series, either post-test or pretest/post-test

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Appropriate management of peritoneal equilibration testing in patients with end-stage kidney disease (ESKD) on peritoneal dialysis

There is some evidence that there is a group of patients with high transporter status who have an increased mortality and an increased risk of technique failure, even with adequate small solute clearance; however, this is not conclusive.

Implementation and Audit

Reporting of peritoneal transport parameters to the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) on an annual basis should be encouraged. ANZDATA should report outcomes according to peritoneal transport status.

Living with Illness

Effectiveness

• Peritoneal transport and ultrafiltration. Nephrology 2005 Oct;10(S4):S104-7.



• Peritoneal transport and ultrafiltration. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2004 May. 10 p. [48 references]

Not applicable: The guideline was not adapted from another source.

2005 Oct

Caring for Australasians with Renal Impairment - Disease Specific Society

Industry-sponsored funding administered through Kidney Health Australia

Not stated

Authors: David Harris, Convenor (Westmead, New South Wales); Merlin Thomas (Prahran, Victoria); David Johnson (Woolloongabba, Queensland); Kathy Nicholls (Parkville, Victoria); Adrian Gillin (Camperdown, New South Wales)

All guideline writers are required to fill out a declaration of conflict of interest.

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI Institute on April 22, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.