Encapsulating Peritoneal Sclerosis: An Unpredictable and Devastating Complication of Peritoneal Dialysis

Chin, Andrew I.; Yeun, Jane Y.

doi:10.1053/j.ajkd.2005.12.049

Cited by 45 publications

(44 citation statements)

References 78 publications

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“…In reaction to multiple insults with (for example) glucose, mesothelial cells secrete cytokines that subsequently lead to recruitment of macrophages and fibroblasts (26). Peritoneal fibrosis is then a result of disrupted repair, with fibrin deposition on a denudated mesothelial cell layer (2). Perhaps this repair process is more vigorous in younger patients, leading to earlier development of fibrosis.…”

Section: Regression Analysismentioning

confidence: 99%

“…The widely accepted "second hit" theory assumes a peritoneum progressively damaged by prolonged use of dialysis fluids, which may be complicated by factors that aggravate the peritoneal sclerosis (1). The bioincompatibility of dialysis fluids-in particular, the unphysiologically high glucose concentrations and the presence of glucose degradation products-are thought to be key elements in this process (2). Some agents, such as chlorhexidine (3) and practolol (4), have been identified as possible "second hits" and are therefore no longer used.…”

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confidence: 99%

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Risk Factors Associated with Encapsulating Peritoneal Sclerosis in Dutch Eps Study

et al. 2011

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ORIGINAL ARTICLES♦ Objective: Encapsulating peritoneal sclerosis (EPS) is a serious complication of peritoneal dialysis (PD) with a multifactorial pathophysiology and possible increasing incidence. The aim of the present study was to evaluate the independent associations of PD duration, age, dialysis fluids, and kidney transplantation with EPS. ♦ Methods: A multicenter case-control study was performed in the Netherlands from 1 January 1996 until 1 July 2007. The population comprised 63 patients with EPS and 126 control patients. Control patients were selected from the national registry and were matched for date of PD start. Associations were analyzed using a log linear regression model. Primary outcome was appearance of EPS. ♦ Results: Compared with control patients, patients with EPS were younger at the start of PD (34.7 ± 15.4 years vs. 51.5 ± 14.7 years, p < 0.0001). The cumulative period on PD was longer in EPS patients than in control patients (78.7 ± 37.8 months vs. 32.8 ± 24 months, p < 0.0001), and the cumulative period on icodextrin was also longer in EPS patients (32.7 ± 23.3 months vs. 18.1 ± 15.7 months, p = 0.006). Compared with control patients, more EPS patients underwent kidney transplantation (47 vs. 59, p < 0.0001). With regard to the period after transplantation, the yearly probability of EPS increased in the year after transplantation to 7.5% from 1.75%. In multivariate regression analysis, cumulative PD duration, age at PD start, transplantation, time from last transplantation to EPS, calendar time, time on icodextrin, and ultrafiltration failure were independently associated with EPS. Transfer from PD to hemodialysis for reasons other than suspected EPS could not be identified as a risk factor for EPS. ♦ Conclusions: Duration of PD, age at PD start, kidney transplantation, time since last transplantation, ultrafiltration failure, and time on icodextrin were associated with a higher risk of EPS. Perit Dial Int

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Section: Regression Analysismentioning

confidence: 99%

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confidence: 99%

Risk Factors Associated with Encapsulating Peritoneal Sclerosis in Dutch Eps Study

et al. 2011

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“…There had been reports so far that revealed beneficial effects of various therapeutic agents, like N-acetyl cystein, rosiglitazone, renin angiosystem blockers, monotherapies with mTOR inhibitors, and steroids alone on EPS models. 8,20,21,24,25 This report is the rare kind of its that underlines the beneficial effect of sirolimus or prednisolone alone on EPS model, but no further improvement with combination however.…”

Section: Discussionmentioning

confidence: 99%

“…3,6,7 Major risk factors are PD itself, duration of PD, exsposure to bioincompatible dialysis solutions, discontinuation of PD, infectious peritonitis attacks, and renal transplantation on probable genetic susceptibility. 3,5,8,9 The pathologic culprit is epithelial-to-mesenchymal transition (EMT) of mesothelial cells that results in tissue remodeling from an inflammatory to a fibrotic state. 4,[10][11][12] Major stimulatory factors are proinflammatory cytokines (TNF-α, IL-1β, IL-6, IL-18), transforming growth factor-β1 (TGF-β1), and vascular endothelial growth factor (VEGF).…”

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confidence: 99%

The Effect of Steroid-Sirolimus Combination on the Experimental Model of Encapsulating Peritoneal Sclerosis in Rats

Ersan¹,

Çelik²,

Çelik³

et al. 2015

Turkiye Klinikleri J Nephrol

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A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Encapsulating peritoneal sclerosis (EPS) is a devastating complication of peritoneal dialysis terminating with peritoneal sclerosis and coccooning of intestinal loops. The inhibitors of mammalian target of rapamycin (mTOR), everolimus and sirolimus, have attenuated EPS findings in experimental animal models. The effect of combination of sirolimus with steroid has not been documented so far. The aim of the study was to determine the effect of combination of sirolimus and steroid on experimental sclerosing peritonitis model. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : 41 wistar albino male rats were divided into 6 groups : control group (C; isotonic saline injected intraperitoneally), chlorhexidine gluconate group (CG; model group), resting group (R; CG then peritoneal rest, prednisolone group (P; CG then prednisolone), sirolimus group (Sir; CG then sirolimus), and prednisolone-sirolimus group (P-Sir; CG then prednisolone plus sirolimus). Peritoneal specimens obtained after sacrification at the end of study were examined for peritoneal thickness, fibrosis, and vascular intensities under light microscopy. R Re es su ul lt ts s: : In the CG and R groups there was a significant increase in peritoneal thickness, fibrosis score and vascular intensity compared to C, P, Sir, and P-Sir groups in both parietal and visceral peritoneum (p<0.05). The parameters at the end of the study were not different in C, P, Sir, and P-Sir groups. The difference between P, Sir, and P-Sir groups were not significant. Resting was shown to be ineffective in attenuating EPS parameters. C Co on nc cl lu us si io on n: : In this study we observed that sirolimus-prednisolone combination was equally effective in experimental EPS model compared to prednisolone and sirolimus only regimens.K Ke ey y W Wo or rd ds s: : Peritonitis; sirolimus; models, animal; adrenal cortex hormones; peritoneal dialysis Ö ÖZ ZE ET T A Am ma aç ç: : Enkapsüle periton sklerozu (EPS), periton sklerozu ve intestinal segmentlerin koza şeklinde sarılması ile sonuçlanan ciddi bir periton diyalizi komplikasyonudur. Memelilerde rapamisin hedefi inhibitörleri (mTOR), everolimus ve sirolimus, deneysel hayvan modellerinde EPS bulgularını azaltmışlardır. Steroid-sirolimus kombinasyonunun etkisine yönelik yapılan bir çalışma bulunmamaktadır. Bu çalışmada deneysel sklerozon peritorit modelinde sirolimus ile steroid kombinasyon tedavisinin etkisini belirlemek amaçlanmıştır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : 41 wistar albino erkek sıçan 6 gruba ayrıldı: kontrol grubu (C; intraperitoneal izotonik serum), klorheksidin glukonat grubu (CG; model grup), dinlenme grubu (R; CG sonrası periton dinlenme), prednizolon grubu (P; CG sonrası prednizolon), sirolimus grubu (Sir; CG sonrası sirolimus) ve prednizolon-sirolimus grubu (P-Sir; CG sonrası prednizolon ve sirolimus). Periton örnekleri ışık mikroskobisi ile; periton kalınlığı, fibrozis skoru ve damar yoğunluğu için değerlendirildi. B Bu ul lg gu ul l...

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“…The medical treatment of EPS, up to now, covers immunosuppressants and antiestrogens (tamoxifen), although the evidence is only based on case reports [34, 35]. The possible pathomechanism explained here would give arguments for a first trial with bevacizumab and or the addition of tryptase to PD fluids as a treatment for EPS.…”

Section: Discussionmentioning

confidence: 99%

Fibrogenic Growth Factors in Encapsulating Peritoneal Sclerosis

et al. 2009

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Background: Increased local levels of fibrogenic growth hormones contribute substantially to the process of encapsulating peritoneal sclerosis (EPS) in animal models. Methods: We analyzed probes from patients with normal kidney function (n = 10), with normal kidney function and inflammation (n = 10), on PD without (n = 10) and with EPS (n = 9). We investigated the degree of fibrosis and the number of vessels and vasculopathy. Additionally, we investigated the expression of NFκB, TGFβ1, TGFβ1 receptor, TGFβ2, TGFβ2 receptor, FGF-BP, CTGF and VEGF by immunohistochemistry. Results: In EPS, we found an exclusive upregulation of VEGF (normal 0, appendicitis 1.0 ± 1.2, PD 1.7 ± 1.8 and EPS 5.7 ± 4.4; p < 0.0001), whereas in PD, CTGF was significantly increased (normal 6.0 ± 2.8, appendicitis 7.3 ± 2.5, PD 10.0 ± 1.8 and EPS 7.3 ± 2.1; p = 0.0059). The results for the TGFβ system and NFκB were not uniform, in EPS no increases were demonstrable. Vasculopathy was significantly more pronounced in EPS (normal 0.4 ± 0.5, appendicitis 0.2 ± 0.3, PD 1.0 ± 0.7 and EPS 1.6 ± 1.2; p < 0.0001) than in PD or inflammation (normal 30 ± 16, appendicitis 82 ± 48, PD 1,936 ± 952 and EPS 2,613 ± 1,209; p < 0.0001), whereas the density of vessels were decreased (normal 125 ± 114, appendicitis 817 ± 347, PD 81 ± 57 and EPS 36 ± 33; p < 0.0001). Conclusions: The process of EPS was associated with increased VEGF in the peritoneum. The reduced density of vessels compared with marked fibrosis could point to hypoxia as an inducer.

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Encapsulating Peritoneal Sclerosis: An Unpredictable and Devastating Complication of Peritoneal Dialysis

Cited by 45 publications

References 78 publications

Risk Factors Associated with Encapsulating Peritoneal Sclerosis in Dutch Eps Study

Risk Factors Associated with Encapsulating Peritoneal Sclerosis in Dutch Eps Study

The Effect of Steroid-Sirolimus Combination on the Experimental Model of Encapsulating Peritoneal Sclerosis in Rats

Fibrogenic Growth Factors in Encapsulating Peritoneal Sclerosis

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