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August 2, 2011, 11:19 AM #1Resource/Policy Associate Registered User
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The KDOQI PD Guideline recommends performing an initial peritoneal equilibration test about 1 month after a new PD patient starts dialysis to rule out unsuspected problems and to determine whether CAPD or CCPD would provide the best toxin removal based on how quickly wastes cross the peritoneal membrane. The Interpretive Guidance to the ESRD regulations followed KDOQI guidelines and tells surveyors to look to see if the PET results were taken into consideration in assessing the appropriate dialysis prescription.
I have heard that some dialysis facilities no longer do a baseline PET and some medical directors believe a baseline test is less meaningful than a test when adequacy problems start to occur. Do you know what the current community consensus is related to performing a baseline PET?Beth Witten MSW ACSW LSCSW
Medical Education Institute, Inc.
September 14, 2011, 10:07 AM #2Member Registered User
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First, I apologize for being so late replying to this question about PETs.
ISPD standards indicate a PET should be performed after the patient is on PD a month, giving the peritoneal membrane time to adjust to the presence of dialysis solutions. THere is probably not much clinical difference if you perform the PET earlier, but in a purely evidence based question, there have been statistical differences in PETs performed earlier than 1 month versus after 1 month. At any rate, an initial PET should be done to assist in the best prescription for the patient to meet appropriate target clearances and as a baseline for further evaluations of changes in the membrane (see ISPD.org guidelines on solute and fluid removal by Lo et al). While it is true that clinical changes will most likely indicate changes in membrane function, it is important to know where the patient is at baseline. If a clinic is omitting initial PETs because of the large time required by the staff to perform the standard PET, a short PET can be done with little inconvenience for either patient or nurse. Published studies have shown no difference in results with standard vs short PET.