A total of 111 patients were identified; the mean time on PD was 82 months (range 8-247). Mortality increased with length of time on PD, being 42% at <3 years (n = 12), 32% at 3-4 years (n = 19), 61% at 5-6 years (n = 31), 54% at 7-8 years (n = 24), 75% at 9-10 years (n = 8) and 59% at >10 years (n = 17). Twelve patients had no previous peritonitis episodes, 28 had one previous episode, 30 had two previous episodes and 33 had three or more previous episodes. Of the patients with PD details available, 41/63 were high (>0.81) transporters and 44/71 had ultrafiltration <1 l/24 h, but 7/63 were low average transporters (0.5-<0.65) and 27/71 had ultrafiltration >1 l/24 h and a few had significant residual renal function. Sixty-five (59%) patients had their PD discontinued prior to diagnosis (51 HD; 14 transplanted). CT scans were performed on 91 patients and laparotomy on 47 patients. Drug treatment consisted of tamoxifen, immunosuppression or both. The median survival was 15 months in patients treated with tamoxifen (n = 17), 12 months in patients treated with immunosuppression (n = 24) and 21 months in patients who received both (n = 13), against 13 months (n = 46) in patients who received no specific treatment. Adhesionolysis was performed in 5 patients, and 39 patients were given parenteral nutrition. The overall mortality was 53% with a median survival of 14 months and a median time to death of 7 months. Conclusion. This is one of the largest cohorts of patients with EPS in the literature. Long-term survival occurred in over 50%, regardless of the various treatments strategies undertaken by the centres.

Background and objectives: Encapsulating peritoneal sclerosis (EPS) is a severe peritoneal fibrotic reaction in patients on long-term peritoneal dialysis (PD). The early clinical features may be nonspecific. The purpose of the study is to assess the reliability and diagnostic utility of abdominal CT scanning in the diagnosis of EPS.Design, setting, participants, & measurements: Abdominopelvic CT scans of 27 patients diagnosed with EPS on clinical and radiologic grounds in our unit from 1997 to 2006 were retrospectively analyzed. In addition, 35 control CT scans were scored: 15 from hemodialysis patients (HD controls) and 20 from patients on PD (PD controls). Scans were anonymized and scored independently by three radiologists.Results: Inter-rater agreement was moderate to very good (kappa ‫؍‬ 0.40 to 0.75) for peritoneal calcification, bowel distribution, bowel wall thickening, and bowel dilation but poorer for loculation of ascites and peritoneal thickening. There was a strongly significant difference between the total CT scan scores at EPS diagnosis and controls (P < 0.00001). Each individual parameter also showed significant differences between EPS and controls (P < 0.006). Bowel tethering and peritoneal calcification were the most specific parameters, and. loculation was the least discriminatory parameter. Interestingly, prediagnostic scans a median of 1.5 yr before EPS diagnosis were normal or near-normal in 9 of 13 EPS patients.Conclusions: CT scanning is a valid and reliable adjunct to the diagnosis of EPS but may not be useful as a screening tool, as the prediagnostic scans did not show abnormalities in many patients who subsequently developed EPS.

Male patients awaiting their first organ transplant had a fourfold increased risk of developing HLA antibody if they had been previously transfused when compared with those who did not have a history of a transfusion. Transfusion even in the postleukodepletion era continues to pose a significant risk of sensitization.

that age-related criteria to start RRT may have been in place. However, for the age range of 50-59 years, on which they base their argument, this is unlikely. The curve of the 1991-1995 period that these authors deleted is until the age of 59 essentially similar to that of the most recent 2006-2010 period.Rodriguez-Osorio et al. cite a recent report from the US that described an increase in age of ADPKD patients at start of RRT to support their notion. 2 However, this report concerns a single center experience over a 50-year period starting in 1961, when RRT was not available for yet a decade, and reporting on only 280 ADPKD patients that started RRT. In our opinion no firm conclusions can be drawn on this small dataset. Of note, recently two large scale randomized controlled clinical trials were published that showed that neither strict blood pressure control, nor double RAAS (renin-angiotensin-aldosterone system) inhibition reduced the rate of renal function decline in ADPKD patients. 3,4 On the basis of these RCT data and our full dataset, we remain of the opinion that there are no clear indications that for ADPKD effective renoprotective therapies have emerged during the last decades. 1. Rodriguez-Osorio L, Perez-Gomez MV, Ortiz A. Decreasing incidence of renal replacement therapy over time at the critical 50 to 59 years age range suggests a role for nephroprotective therapy in ADPKD. Kid Int 2015; 88: 194. 2. Helal I, McFann K, Reed B et al. Changing referral characteristics of patients with autosomal dominant polycystic kidney disease. Am J Med 2013; 126: 832 e7-832.e11. 3. Schrier RW, Abebe KZ, Perrone RD et al. Blood pressure in early autosomal dominant polycystic kidney disease. N Engl J Med 2014;

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