Peritoneal Transport Characteristics Among Pakistani Patients Undergoing Peritoneal Dialysis

Abstract

Background: The peritoneal membrane acts as a biological filter to remove solutes and fluids during peritoneal dialysis, a well-known kind of renal replacement treatment. Dialysis prescriptions and clinical results are directly influenced by the four transport categories that the peritoneal equilibration test assigns to patients: low, low-average, high-average, and high. The published literature still lacks population-specific transport data from Pakistan.

Objective: To determine the distribution of peritoneal transport types among Pakistani patients undergoing peritoneal dialysis and to evaluate the demographic, clinical, and biochemical variables associated with transport status.

Materials and Methods: Four tertiary care hospitals in Lahore participated in a multicenter, cross-sectional, observational study. One hundred adult patients receiving continuous ambulatory peritoneal dialysis underwent a standard peritoneal equilibration test six weeks after dialysis began. Transport categorization was done using the Twardowski criterion and the 4-hour dialysate-to-plasma creatinine ratio.

Results: High-average and high transporters collectively constituted 77% of the study population (57% and 20%, respectively). Older age (p = 0.02), lower body mass index (p = 0.02), diabetic nephropathy (p = 0.03), hypoalbuminemia (p < 0.001), raised C-reactive protein (p < 0.001), and decreased net ultrafiltration volume (p < 0.001) were all substantially correlated with higher transport status.

Conclusion: A marked predominance of high peritoneal transport phenotypes was identified in this Pakistani population, attributed to the compounding influence of diabetic nephropathy, systemic inflammation, and nutritional deficits. These findings underscore the need for transport-guided dialysis prescription in this clinical setting.