Prognosis of Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD) for Over 10 Years

Abstract

Background Patients who have been on continuous ambulatory peritoneal dialysis (CAPD) for over 10 years are known to have a risk of developing encapsulating peritoneal sclerosis (EPS). However, the prognosis of patients on CAPD for over 10 years remains unclear. Methods To better understand the efficacy of a variety of treatments for EPS, we retrospectively reviewed 25 patients who started CAPD at Toranomon Hospital from 1981 to 1997 and continued it for longer than 10 years. Results The CAPD catheter was removed without peritoneal lavage in the initial 3 patients and they developed massive ascites. They all died of infection without resolution of the ascites. Accordingly, in the remaining 13 patients who did not undergo kidney transplantation, peritoneal lavage therapy was performed for 12 months before removing the CAPD catheter. As a result, 4 patients did not develop EPS. However, 9 patients had EPS with ascites, among whom 4 died of EPS-related diseases and 5 are alive. Five patients underwent cadaveric donor kidney transplantation. At the time of surgery, the CAPD catheter was removed without peritoneal lavage; 1 patient suffered from massive ascites immediately, although this subsided within 3 months after kidney transplantation, and 4 patients remain free from EPS-related symptoms and are doing well. Conclusion Kidney transplantation may be an option for preventing EPS. This study showed that improvement of the uremic state as well as treatment with immunosuppressants including corticosteroids may contribute to preventing EPS.

Transcriptional Patterns in Peritoneal Tissue of Encapsulating Peritoneal Sclerosis, a Complication of Chronic Peritoneal Dialysis

“…EPS rates among 7000 patients from Australia and New Zealand were 0.3% after 3 years on PD, 0.8% after 5 years, and 3.9% after 8 years [9], but 8.1% of UK patients treated with PD for 5 years developed EPS [10]. In a Japanese cohort of PD patients with overall EPS incidence of 2.5%, EPS was diagnosed in 17–70% of patients with PD duration >15 years [11], [12], [13]. 72% of EPS is recognized only after discontinuation of PD due to ultrafiltration failure, switch to hemodialysis, or transplantation [9].…”

After peritoneal dialysis discontinuation: When will we remove peritoneal dialysis catheter?

“…Many Japanese investigators reported the effect of peritoneal lavage to reduce the risk of EPS. [15][16][17][18][19] The method of peritoneal lavage is washing peritoneal cavity with saline or low-glucose PD solutions for several months (in some cases, over years) after PD discontinuation. Yamamoto et al analyzed 247 patients with PD discontinuation for the effect of peritoneal lavage in prevention of EPS.…”