Peritoneal Membrane Transport Characteristics in Uni-PET with Preceding Icodextrin Dwell as Compared to Classic PET with Preceding Glucose Dwell: A Prospective Study

Abstract

Background: In subjects on CAPD who use icodextrin for long night dwell, it has been recommended that nocturnal exchange be replaced by dextrose dwell whenever PET is to be performed as preceding exchange with icodextrin temporarily increases peritoneal membrane permeability and therefore, gives high D/PCr and low D/D 0 glucose values. Whether this temporary change is also seen with use of Uni-PET (which involves one hour dwell of 1.5% dextrose followed by 4-hour dwell of 4.25% dextrose) is not known. Methods: In this self, controlled study, subjects on CAPD, who were using icodextrin for long nocturnal dwell for at least 3 months, were screened for enrolment. Pregnancy or lactation, history of any PD related infectious complication in the past one month, present or past malignancy, and poor functional status were exclusion criteria. Enrolled subjects underwent classic PET with preceding 2.5% dextrose long nocturnal dwell on day 1 followed by Uni-PET with preceding 7.5% icodextrin long nocturnal dwell on day 2. Difference in D/PCr and D/D0 glucose between the two PETs was primary objectives. The study was approved by Institute Ethics Committee. Results: 15 out of 26 screened subjects were enrolled over a period of 18 months (July 2015-December 2016). The mean (±SD) age of study population was 60.8±9.1 years. Majority were males and diabetes was the most common cause of CKD. Mean D/PCr were 0.68 ± 0.11 and 0.64 ± 0.08 in classic PET and Uni-PET, respectively. The difference between the two values was not significant [mean difference between D/PCr (classic PET-Uni-PET): 0.040 ± 0.86; 95% CI (-0.007 to 0.088); p = 0.09]. Similarly, D/D 0 glucose between classic PET and Uni-PET was also similar [mean difference between D/D0 glucose (classic PET-Uni-PET): -0.02 ± 0.09; 95% CI (-0.06 to 0.03); p = 0.448]. Conclusion: Peritoneal membrane small solute transport characteristics in Uni-PET with preceding icodextrin dwell are similar to classic PET with preceding glucose dwell. If Uni-PET is used, it may not be necessary to replace preceding nocturnal exchange of icodextrin with that of dextrose as is currently advised.