I am 86 years old and have been on PD for 2 years

I just had my current PET and would like to know what it means when you go from a low average to a high average.
I am also getting ready for an adequacy test the end of this month, and would like to know if there is anything I can do to bump up my results as I have been in the hospital 4 times in the last 3 months.

I know that 1.7 is the base but before the hospital visits I was a 1.95 for adequacy. I am now a 1.45.
Not good.
Any help would be appreciated.

Here’s info on the peritoneal equilibration test (PET) that describes the test and what the results mean so far as which type of PD is best based on how high or low the rate of toxin transport across the peritoneal membrane.

What were you in the hospital for? When was the PET done? Was the PET done correctly? If your Kt/V is dropping you may need a change in your PD prescription. I’d suggest you talk with your doctor about your concerns.

Hi Beth:
Sorry it took so long to answer you. I am typing this for my Husband and we are a bit confused. We have clinic through Davita in Pahrump, NV and a lot has changed lately.
My Husband was in the hospital 3 times for high ammonia levels even though his liver is fine. Before these hospital stays he had UTI’s and then at the same time he was diagnosed with a Superbug Ecoli that was almost untreatable. They gave him Meripenum.
The problem is I am not getting straight answers from his nephologist and concerned because he says my Husband needs Hemodialysis and that his membrane has deteriorated. If this is true how can he pass a PET test with a high average.
Also, since he came out of the hospital he has almost quit urinating. He was really doing great with that and now nothing.
We are getting ready for an adequacy test next week and he says that we will see what it shows and possibly add a extraneal bag and see if we can bring his number back.
I am finding it very hard to believe he is for my Husband and not just trying to get him to quit PD. He is trying to lump him in with all his other patients so I am trying to get a second opinion. Anything you can give me would be helpful. I really don’t want him to go back on Hemo because it was very hard on him the first time. He died for 10 minutes after the first prescription was administered in 2016.
Perhaps you can inquire what others think there too and come up with something. I can provide more information if you want.
Thanks so much,
Judy Pierce

High ammonia levels in blood (blood urea nitrogen or BUN) can indicate liver disease (which you say he doesn’t have), and it can indicate kidney failure. People with kidney failure can have breath or skin that smell like ammonia from uremia when dialysis isn’t working as well as it should.

The peritoneal equilibration test (PET) reports how fast/slow wastes are transported across the peritoneal membrane in PD. The adequacy test (Kt/v) should let you know how much waste is being removed by PD. The test result should at least be 1.7 at a minimum. If he’s a fast transporter, doing 4 or more manual exchanges per day might remove wastes better than doing PD overnight with a cycler. Kidney School has a module on lab tests that might help you understand the results he’s getting. You might ask for a copy of his labs so you can track them and look at them in light of symptoms he’s having.

PD is a great first treatment for people with kidney failure, but over time as the urine output declines, PD does not work as well and patients often switch to hemodialysis. Kidney School has a module on treatment options.

If your husband needs to do dialysis in a clinic, staff should be paying more attention nowadays to how much fluid they’re removing over the prescribed dialysis time. Patients and staff have to work together on fluid management and the dietitian can be really helpful. Gaining too much fluid and trying to remove it too fast can “stun” organs and cause symptoms like low blood pressure, cramps, and can even cause heart damage/failure. This calculator shows that it is unsafe to remove 13 ml/kg or more of fluid per hour of dialysis.

Longer slower hemodialysis treatments are better requiring less time after dialysis to feel OK. Some patients do hemodialysis overnight at home or in-center to allow slower removal of fluid. You might want to ask his doctor about that. DaVita’s website has information about nocturnal dialysis and a number to call to find out where it’s offered.