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To those new to peritoneal dialysis, things can fly by with those involved wondering what happened. In this blog, I am going to lay out the basic sequences involved in getting set up for, and continuing a peritoneal dialysis routine.

First some terms in the sequence:

  1. Initial setup
  2. PET
  3. Transport
  4. Prescription
  5. Adequacy Test
  1. Initial setup: Let’s assume that a decision you were part of has already been made that you need to go on peritoneal dialysis. Now what? You will need to have a catheter installed in your stomach which was an outpatient procedure for me and relatively painless but did involve an entire day. You need to get in the queue at your dialysis provider, Fresenius for me, for training. Depending on their scheduling, it may take several weeks to schedule your training, and up to two weeks or more to complete the training. During the training, you will be taught how to do both manual and automated peritoneal dialysis. During the manual training, my dialysis team conducted a PET.
  2. PET. What is dialysis PET? In the context of ascertaining transport in peritoneal dialysis (PD), the Peritoneal Equilibration Test (PET) is a procedure used to evaluate the peritoneal membrane’s transport characteristics. During a PET, a defined dialysis solution with glucose concentrations of varying strengths is infused into the peritoneal cavity. The solution remains inside the abdomen for a specified dwell time before being drained. The transport status of the peritoneal membrane can be determined by measuring the levels of glucose and other solutes in the drained solution. The results of the PET help classify patients into different transport categories, such as high, high-average, low-average, or low transporters. This information is crucial in tailoring the peritoneal dialysis prescription and optimizing treatment outcomes for individual patients. The mechanics of the test follow: The night before the test I do a mechanical fill of 2000 mL of 2.4 % dialysis fluid which stays in my stomach all night while I sleep. The next morning I go to the clinic where three more manual exchanges are made to accomplish the measurements and sampling outlined previously. A PET is normally conducted annually.
  3. Transport: Now that the transport status of the peritoneal membrane is determined, the results of the PET help classify patients into different transport categories, such as high, high-average, low-average, or low transporters. This information is crucial in tailoring the peritoneal dialysis prescription and optimizing treatment outcomes for individual patients. Please note that this “transport” is not a one-and-done procedure as transport may change over time due to changes in the stomach lining to the movement of the catheter within the stomach as was my case.
  4. Prescription: Once the transport function has been ascertained, there are research-based tables that suggest what prescription is best fitted for you. The prescription sets forth how much total fluid, how long it will stay in your stomach (dwell), and how often it will be exchanged. These values are embedded on a thumb drive for the Fresenius Liberty Cycler which in turn “programs” it to your prescription. At this point, your cycler is in automatic and you’re good to go.
  5. Adequacy Test: Now that we are rolling along on peritoneal dialysis, a question is “How well is our current prescription working?” This is where the adequacy test comes in. Normally conducted quarterly, The peritoneal dialysis adequacy test is a procedure used to assess the effectiveness of peritoneal dialysis (PD) in removing waste products and excess fluids from the body. The test measures the clearance of urea, a waste product that accumulates in the bloodstream when the kidneys fail to function properly. It involves collecting a sample of peritoneal dialysis effluent and measuring the concentration of urea in the sample. By comparing this concentration with the urea levels in the blood, dialysis adequacy can be determined. The test takes into account factors such as the volume and composition of the dialysis solution, the dwell time, and the patient’s body size. Adequacy targets are established based on individual patient characteristics and established guidelines. Regular monitoring of dialysis adequacy is essential to ensure that patients receive optimal treatment and to make any necessary adjustments to the dialysis prescription.

The bottom line of the adequacy test is a lab-provided number of a formula for Kt/V whose target is 2.0 or greater. If it is 1.70 or less, your prescription is not working well enough and must be changed. The variables involved in your prescription, solution strength, solution amount, and dwell times might have to be adjusted to drive Kt/V more positively. I am in this interaction as we speak. I had another PET, and am scheduled for another adequacy test in the near future.

And that boys and girls, is in general, at least for me, been what’s involved in getting set up and conducting peritoneal dialysis in the course of 16 months or so. The Big Picture if you will. Poe provided the lead graphic and aided in writing this blog.