Encapsulating Peritoneal Sclerosis in Long-Termed Peritoneal Dialysis Patients

Abstract

Background Encapsulating peritoneal sclerosis (EPS) is a rare but serious clinical complication of long-term peritoneal dialysis (PD) patients with high mortality. The purpose of this study was to assess the clinical characteristics of patients with EPS and to search for possible factors useful for EPS prevention and early diagnosis. Method This retrospective study was performed in a single dialysis center in Taiwan between August 1990 and April 2014. Overall, a total of 565 patients were included and the medical records of those patients who had developed EPS (EPS group) and those who had not developed EPS (control group) were collected. We compared several factors between these two groups. Result In the univariate analysis, EPS was significantly associated with a change of transport state (Delta 2) (p = 0.007), duration of PD (p < 0.001), duration of peritonitis treatment (p = 0.001), number of peritonitis episodes (p = 0.002), and fungus related peritonitis (p = 0.031). After multivariate logistic model analysis, we found that only the duration of PD was independently significantly associated with EPS (p = 0.034). In addition, we used the ROC curve and found that a duration of peritoneal dialysis of about 8.4 years is the best cut-off point to predict EPS occurrence. Conclusion In this study, long-termed PD duration is the only strong independent risk factor for EPS development. Total peritonitis times, total peritonitis treatment duration, and marked increased peritoneal D/Pcr ratio were also significantly associated with the duration of PD.

Encapsulating Peritoneal Sclerosis: Pathophysiology and Current Treatment Options

“…The pathogenesis of EPS is multifactorial with various initiating and accelerating factors at different stages of the disease [7] (Figure 1). The unanimously recognized risk factor for EPS is long-term PD [19,20,21,22,23,24,25,26,27,28,29]. There is a strong linear correlation between PD duration and the frequency of EPS.…”

“…Integrating the data regarding pathophysiology and the clinical observations, the risk factors for developing EPS are several but the predominant ones are the duration of PD treatment and the episodes of peritonitis during the course of the treatment [10,13,19,20,21,22,23,24,25,26,27,28,29,30,33]. PD duration as a risk factor involves the constant and chronic effects that the PD fluid constituents (high glucose, lactate, low pH) have on the PM along with the mechanical effects on the PM by the fluid introduction into the cavity.…”

A hypoglykaemia megelőzése előrehaladott veseelégtelenségben szenvedő diabeteses betegek kezelése során

“…A peritoneális membránfelszín -a szöveti struktúra változásait kísérő -transzportkarakter-változása a glükóz átjutási sebességének módosulása miatt labilis szénhidrátanyagcsere kialakulását okozhatja. 29 Alternatív ozmotikus ágens is használt a klinikai gyakorlatban, ez az icodextrin (monoszacharid egységekből álló, maltóztartalmú polimer, glükózt nem tartalmaz). Ellentétben a glükózalapú oldatokkal ez hosszabb idő alatt sem szívódik fel a hashártya üregéből, így tartós ozmotikus szívóhatást fejt ki.…”

Risk factors for Encapsulating Peritoneal Sclerosis in patients undergoing peritoneal dialysis: A meta-analysis

“…Many factors including duration of PD, age at initiation of PD, bio-incompatible dialysate, high-transporter membrane, duration of UFF (ultrafiltration failure), duration of peritonitis, number of peritonitis episodes, and kidney transplantation may lead to EPS [ 1 , 17 , 19 , 20 ]. However, both a single-center retrospective study from Taiwan and dual-center retrospective study from Iran analysed the relationship between age at PD onset and the development of EPS, with the latter concluding that younger age was a high-risk factor for EPS [ 21 ], while the former found no significant difference according to age [ 22 ]. The question, therefore, ‘What are the risk factors related to EPS in PD patients?’ remains unanswered.…”