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.

Global Prevalence of ESRD on RRT Lysaght, J Am Soc Nephrol, 2002 Saudi Center for Organ Transplantation, Annual Report

PD in KSA Saudi Center for Organ Transplantation, Annual Report

Important to understand To tailor the therapy To improve adequacy To improve technique survival Membrane Physiology and Transport Kinetics for the target population

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 Low Transporter < 0.50 High- average High Transporters > 0.80

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

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

Primary cause of ESRD

ST DEVMAXMINMEAN BMI BSA RESIDUAL RENAL FUNCTION (ML/DAY) Patient characteristics  The average age 50.5 yrs  24 patients were above 60 yrs of age

UREACRTCAPHOSPTHHB ALBU MIN Total Kt/V Total Cr Cl L/wk Hb Gm/dl EPO DOSE Mean Min Max ,000 Std dev Results

 The average daily glucose exposure was ( ± 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 transporter7 High Average19 Low Average13 Low Transporter1 RESULTS Membrane type in Saudi patients

DIABETIC PATIENTS

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). 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