PERITONEAL MEMBRANE CHARACTERISTICS IN SAUDI PATIENTS

Prof. Jamal Alwakeel,

Dr Saira Usama

Dr Abdulkareem Alsuwaida,

Dr Mohammad AL Ghonaim,

Dr Akram Askar,

Dr Niaz Feraz,

Dr Shahid Qayyum

Dr Abdo Qudsi.

426,000

1,065,000

2,095,000

1990 2000 2010

Global Prevalence of ESRD on RRT

Lysaght, J Am Soc Nephrol, 2002

Saudi Center for Organ Transplantation, Annual Report 2007 www.scot.org.sa

PD in KSA

Saudi Center for Organ Transplantation, Annual Report 2007 www.scot.org.sa

Membrane Transport Kinetics

Important to understand

To tailor the therapy

To improve adequacy

To improve technique survival

Membrane Physiology and Transport Kinetics

for the target population

Peritoneal Equilibration Test

Globally used

Accurate and reliable over repeated periods of observation

to determine membrane type

Extremely well controlled

In-center procedure

Mujais S, Nolph K, Gokal R, et al: Evaluation and management of ultrafiltration problems in peritoneal dialysis. International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis. Perit Dial Int 20:S5-S21, 2000 (suppl 4)

Low-average 0.50 - 0.65

Low Transporter <

0.50

High-average 0.65 - 0.80

High Transporters > 0.80

Interpretation of PET

Baseline Peritoneal Equilibrium Test

Gokal R, Mallick NP: Peritoneal dialysis. 1999

To identify the characters of membrane permeability in the local Saudi population

assess the role of various factors affecting solute transport across the peritoneal membrane

Aim of the Study

30 female 22 male patients

Standardized Pet test

4

weeks

after i

niti

ati

on

of regul

ar

Di

alysis

Kt/ V and creatinine clearance • 4

-6weeks after initiation of Dialysis

• at 3-4 month intervals

Patients and methods

52 patients in the Peritoneal Dialysis Unit of King Khalid University Hospital, Riyadh

Primary cause of ESRD

ST DEV MAX MIN MEAN

4.57 38.51 12.49 27.13 BMI

0.87 2.11 1.0 1.71 BSA

798 2833 0 610RESIDUAL RENAL FUNCTION (ML/DAY)

Patient characteristics

The average age 50.5 yrs

24 patients were above 60 yrs of age

UREA CRT CA PHOS PTH HB ALBUMIN

TotalKt/V

TotalCr Cl L/wk

HbGm/dl

EPO DOSE

Mean 16.99 702.05 2.27 1.59 58.28 11.02 27.59 1.96 59.59 11.02 7031.5

Min 5.5 89 1.4 0.94 0.34 7.21 7.02 0.79 19.98 7.21 2000

Max 30.7 1322 2.8 2.89 295 15.8 42 5.48 132.87 15.8 30,000

Std dev. 6.45 304.12 0.27 0.79 105.87 1.89 6.91 1.24 24.85 1.89 3577

Results

The average daily glucose exposure was 170.67 (81.6 - 386 ± 58.63) gm per day.

31 patients were using icodextrin either • as night cycle in CAPD or• as Long day dwell in CCPD patients.

PD Fluids

High transporter 7

High Average 19

Low Average 13

Low Transporter 1

RESULTS

44%46%

2%

8%

HighTransporterHigh Average

Low Average

LowTransporter

Membrane type in Saudi patients

DIABETIC PATIENTS

73%

7%4%

8%4%

4%

PRIMARY DISEASE IN > 60 YRS

DM

HTN

GN

NEPHROLITHMM

APCKD

Older Age Group

46 % patients - above 60 yrs of age

COMPARING WITH OTHER

POPULATIONS

54 adult PD patients at Kingston General Hospital, Kingston, Ontario, Canada.

distribution of the patients by peritoneal transport• 0 low • 17 low-average • 22 high-average • 15 high

1. Rachel M. Pilkeyet al Inflammation, Peritoneal Transport, and Response to Erythropoitin in Peritoneal Dialysis Patients Queen’s University and Kingston General Hospital, Kingston, Ontario, Canada Perit Dial Int 31:48–63, 2006

Canada

The study group at Department of Nephrology and Mineral Metabolism, , Mexico DF,

55 patients (29 male, 26 female) Peritoneal transport distribution:

24% - low 29% - low average 34% - high average 13% - high transporter

Angel Diaz-Alvarenga, Marcela Abasta-Jimenez, Bemardo Bravo, Gerardo Gamba, Ricardo Correa-Rotter Serum Albumin and Body Surface Area Are the Strongest Predictors of the Peritoneal Transport Type Perit Dial Int 23:75–89, 2004

Mexico

918 patients from the Australian and New Zealand Dialysis and Transplant registry

153 (16.7%) - H 472 (51.4%) - (HA), 257 (28.0%) - (LA) 36 (3.9%) - (L).

17 %

51 %

%28

4 %

High transporter

High Av-erage

Low Av-erage

1. 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 43:492–501, 2004

ANZDATA

Comparatively Speaking

The results are comparable to other populations

The slight differences could be explained by the pre existing renal disease, co morbidities as well as the racial differences

There is need for a national renal registry to fully understand the membrane kinetics in the local population

CONCLUSION

Thank You