Long-Term Peritoneal Dialysis is a Risk Factor of Sclerosing Encapsulating Peritonitis for Children

Abstract

Objective Sclerosing encapsulating peritonitis (SEP) is a clinical syndrome with a high mortality rate and is a serious complication of peritoneal dialysis (PD). Peritoneal sclerosis (PS) is a histological diagnosis. PS is usually observed in the peritoneal specimens of patients with SEP. Avoiding SEP is considered to be extremely important for pediatric patients who may require long-term PD. In this study, the characteristics of patients with PS were investigated to determine when to perform peritoneal biopsies and how long PD can be performed safely. Design A retrospective single-center study. Setting Tokyo Metropolitan Kiyose Children's Hospital. Patients A total of 109 children younger than 16 years have received chronic PD in our unit since 1981. Among these children, 16 patients had been on PD for more than 5 years (mean 7.4 ± 2.5 years) from May 1992 to March 1999. Peritoneal biopsies were performed in 14 of the 16 patients, who were divided into two groups based on the histological diagnoses: a PS and a peritoneal fibrosis (PF) group. Results The 14 patients were on PD for a mean of 7.8 ± 2.5 years. There were 8 patients with PS and 6 patients with PF. SEP was observed in 2 patients in the PS group. The risk of PS increased with the duration of PD: 57% (8/14) > 5 years, 80% (4/5) > 8 years, and 100% (3/3) > 10 years. All patients in the PS group showed both peritoneal calcifications on abdominal CT scan and poor ultra-filtration at the time of diagnoses. Conclusion Long-term PD was the important risk factor of SEP. If both peritoneal calcification on abdominal CT scan and poor ultrafiltration are observed in a patient on PD more than 5 years, a peritoneal biopsy should be performed. If PS is detected, PD should be discontinued.

Encapsulating peritoneal sclerosis in paediatric peritoneal dialysis patients

“…The outer portion of the peritoneum is usually replaced by hyalinized collagen. 4 All of these histological findings were detected in the first patient in the present study. Kawaguchi et al . proposed that a diagnosis of EPS was based on clinical suspicion and confirmed with radiological findings.…”

“…3,5 It was found that the risk of EPS increased with the duration of dialysis. 1,3,4 Kawanishi et al . reported that there were no cases of EPS in patients with a PD duration shorter than 3 years, and its incidence increased especially after 8 years.…”

“…recommended that if patients receive PD for longer than 5 years and show both ultrafiltration failure and peritoneal calcification on CT, a peritoneal biopsy should be performed. 4 Kawaguchi et al . believed that there are no reproducible and reliable tests to identify patients at high risk of developing this complication.…”

“…The incidence of encapsulating peritoneal sclerosis (EPS) has been reported as 0.77-2.5% in adults and 1.6% in paediatric peritoneal dialysis patients. [1][2][3][4] The diagnosis of EPS is based on clinical, radiological and histological findings. Because of its high mortality rate, patients on longterm peritoneal dialysis (PD), especially patients with impaired peritoneal ultrafiltration, should be followed carefully.…”

Chronic peritoneal dialysis in children

“…The bowels become cocooned in a restrictive fibrocollagenous sheath and may become obstructed. EPS can be associated with high mortality, 60 but in children this is rare. The child is usually unwell, with abdominal symptoms and signs of bowel obstruction.…”