Long-term outcome of encapsulating peritoneal sclerosis (EPS) patients in a single center

Yamahatsu, Aya; Hamada, Chikuma; Kaneko, Kayo; Io, Hiroaki; Nakata, Jun; Tomino, Yasuhiko

doi:10.1007/s10157-015-1081-7

Cited by 11 publications

(12 citation statements)

References 23 publications

(23 reference statements)

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“…In Japan, a staging of EPS based on clinical and laboratory findings has been reported, and the recommended treatment according to the stage has been presented (Table 1) [57]. We performed interventions to PD patients based on EPS staging by laparoscopic and macroscopic findings, and it was possible to prevent the development or progression of EPS, resulting in good prognosis [58]. However, there is no evidence demonstrating the protective effect of peritoneal rest or lavage on the development of EPS so far.…”

Section: Peritoneal Sclerosis – Simple Peritoneal Sclerosis and Sclerosing Peritonitis (Fig 2)mentioning

confidence: 99%

“…Macroscopic observations of the peritoneal cavity using a laparoscope have been performed during operations to manage conditions such as catheter infection, drainage failure, and catheter removal for PD discontinuation. Because it is possible to confirm a partial intestine envelope by NFM by laparoscopy that cannot be detected by CT, early intervention is recommended even for patients with mild clinical symptoms of EPS [58]. When an acidic solution was used as a standard dialysate, the visceral peritoneum of the intestine became severely affected by adhesions, with a yellowish leather-like opaque appearance, such that the vascular network could not be visualized (Fig.…”

Section: Peritoneal Sclerosis – Simple Peritoneal Sclerosis and Sclerosing Peritonitis (Fig 2)mentioning

confidence: 99%

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Recent Understanding of Peritoneal Pathology in Peritoneal Dialysis Patients in Japan

Hamada

Tomino

2021

Blood Purif

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The thin peritoneum covering the peritoneal cavity has been used as a dialysis membrane for peritoneal dialysis (PD) because it is highly vascularized and has a large body surface area. However, it has been reported that peritoneal membranes affected by peritonitis, as well as those exposed to the nonphysiological high glucose levels containing PD dialysate, may undergo histological and functional changes. Patients undergoing PD may experience encapsulating peritoneal sclerosis (EPS), which is a life-threatening serious complication of PD that can significantly impair activities of daily living. The incidence of EPS was 1.4–7.3% of maintenance PD patients in the 1980s. The incidence has improved to 1.0% after a neutral dialysate became the standard PD treatment in Japan. Furthermore, the pathogenesis of EPS is uncertain although its onset may be explained by the “two-hit theory,” in which some factors leading to impairment had an additive effect on simple peritoneal sclerosis. The evaluation of histopathological findings has shown the impact of the neutral dialysate on peritoneal deterioration as well as its role in the development of functional changes. In the present report, we discuss the advances in the understanding of peritoneal deterioration based on histological and macroscopic evaluations of the peritoneum of patients undergoing PD. We also discuss the recent treatment for PD patients.

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Section: Peritoneal Sclerosis – Simple Peritoneal Sclerosis and Sclerosing Peritonitis (Fig 2)mentioning

confidence: 99%

Section: Peritoneal Sclerosis – Simple Peritoneal Sclerosis and Sclerosing Peritonitis (Fig 2)mentioning

confidence: 99%

Recent Understanding of Peritoneal Pathology in Peritoneal Dialysis Patients in Japan

Hamada

Tomino

2021

Blood Purif

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“…Unfortunately, the optimal treatment for EPS is not clear. There are no standard therapies or randomized controlled trials to cure EPS patients but some empiric knowledge based mainly on observational evidences include surgical and medical interventions, might be beneficial [ 8 ]. Generally, PD should be discontinued after the diagnosis of EPS is made.…”

Section: Introductionmentioning

confidence: 99%

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

Zeng

et al. 2022

PLoS ONE

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Purpose Encapsulating Peritoneal Sclerosis (EPS) is the most serious complication of long-term peritoneal dialysis (PD), which considerably reduces the patient’s quality of life, leading to patients discontinuing PD. Considering these negative effects, it is necessary to systematically review and determine the risk factors of EPS. Methods The PubMed, Embase, Web of Science, Cochrane Library, and China Biology Medicine (CBM) were searched from their inception to January 1st, 2022, and the bibliographies from the citations of relevant articles were manually searched. The ROBINS-I (Risk of Bias in Non-randomized studies of Interventions) tool was used to evaluate the risk of bias of included studies. Results Ten studies involving 12595 participants were included in this meta-analysis. The results revealed that a younger age at PD onset (MD = -7.70, 95% CI, -11.53~-3.86), a higher transporter (MD = 0.13, 95% CI, 0.09~0.18), a longer PD duration (SMD = 1.15, 95% CI, 0.68~1.61), a longer peritonitis duration (MD = 12.66, 95% CI, 3.85~21.47), and history of glomerulonephritis (OR = 1.42, 95% CI, 1.02~1.97) were significant risk factors for EPS. However, sex, use of icodextrin, the number of peritonitis episodes, and history of multicystic kidney disease did not affect the risk of EPS. Conclusions This review provides a scientific basis for further understanding the etiology of PD-related EPS and improving prevention strategies. More high-quality studies are necessary to validate this paper’s findings.

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“… 19–24 There is no single satisfactory intervention to cure the patients with EPS but a multidisciplinary approach, which is based on the EPS staging and includes both medical and surgical intervention, might be helpful. 25 It is generally accepted that PD should be discontinued after diagnosis of EPS. Additional interventions include peritoneal lavage, nutritional support, enteral or parenteral nutrition, corticosteroids, tamoxifen, immunosuppression, and enterolysis.…”

Section: Introductionmentioning

confidence: 99%

“…Additional interventions include peritoneal lavage, nutritional support, enteral or parenteral nutrition, corticosteroids, tamoxifen, immunosuppression, and enterolysis. 25 Despite these interventions the mortality rate is still high and varies between 25.8 and 56.5%.…”

Section: Introductionmentioning

confidence: 99%

Risk factors of severe peritoneal sclerosis in chronic peritoneal dialysis patients

et al. 2016

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Peritoneal dialysis (PD) offers the healthiest way for starting renal replacement therapy (RRT) in End Stage Renal Disease patients, however exposes long-term PD patients to a dangerous complication named encapsulating peritoneal sclerosis (EPS). In this study, we searched for possible risk factors of EPS. Data were collected from two PD centers covering period 1995–2012 and comprised 464 patients. Control group defined as PD patients stayed on PD >42 month (n = 122), and case group was 12 confirmed EPS patients. Associations were analyzed using linear regression analysis. Prevalence and incidence of EPS were 2.59% and 8.9% with an incidence of 0.7% patient-years, respectively. The age at start of PD in EPS patients (32.75 ± 10.8 year) was significantly lower compared with control group (49.61 ± 16.18 year, p = .0001). The mean duration of PD in EPS and control group were 2494.4 ± 940.9 and 1890.2 ± 598.8 days (p = .002). Control group had 145 episodes of peritonitis during total duration of 7686 patient months (peritonitis rate of 1/53). This was 1/26 with a total 38 episodes of peritonitis during the total duration of 997 patient months (p = .01) for EPS group. In regression analysis, PD duration, age at PD start and duration of Ultrafiltration failure (UFF) were associated with EPS. Longer time being on PD, younger age, and higher UFF duration were the risk factors for EPS development.

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Long-term outcome of encapsulating peritoneal sclerosis (EPS) patients in a single center

Abstract: There was no significant difference in the survival rate between EPS patients and control PD patients. It appears that an early diagnosis by laparoscopy and accurate treatment, including surgical enterolysis, might improve mortality.

Cited by 11 publications

References 23 publications

Recent Understanding of Peritoneal Pathology in Peritoneal Dialysis Patients in Japan

Recent Understanding of Peritoneal Pathology in Peritoneal Dialysis Patients in Japan

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

Risk factors of severe peritoneal sclerosis in chronic peritoneal dialysis patients

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