Risk Factors Associated with Encapsulating Peritoneal Sclerosis in Dutch Eps Study

Abstract

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

Interstitial Fibrosis Restricts Osmotic Water Transport in Encapsulating Peritoneal Sclerosis

“…[11][12][13] Surprisingly, symptoms of EPS occur after PD withdrawal in most cases. [11][12][13] There are currently no definitive criteria that enable the detection of early stages of EPS. Arguably, a better understanding of the early phase of the disease may help in identifying patients at risk and developing prevention strategies.…”

“…10 EPS is probably a multifactorial disease, in which PD duration represents an important risk factor. [11][12][13] Other conditions that have been inconsistently associated with EPS include cumulative glucose exposure, younger age, peritonitis episodes, b-blockers, and kidney transplantation. [11][12][13] Surprisingly, symptoms of EPS occur after PD withdrawal in most cases.…”

“…[11][12][13] Other conditions that have been inconsistently associated with EPS include cumulative glucose exposure, younger age, peritonitis episodes, b-blockers, and kidney transplantation. [11][12][13] Surprisingly, symptoms of EPS occur after PD withdrawal in most cases. [11][12][13] There are currently no definitive criteria that enable the detection of early stages of EPS.…”

Towards Standardized Reporting in Studies of Encapsulating Peritoneal Sclerosis

“…To minimize diagnostic heterogeneity in a Dutch series of 62 patients, only patients with persistent or recurrent obstruction together with radiologic or macroscopic evidence were included (12). In the single-center Stoke PD cohort, 2 of 11 patients with EPS were considered to present slightly differently, their EPS being associated with early and severe infectious peritonitis (6).…”

Anthropometrics Identify Wasting in Patients Undergoing Surgery for Encapsulating Peritoneal Sclerosis

“…ncapsulating peritoneal sclerosis (EPS) is an uncommon but serious complication of peritoneal dialysis (PD), characterized by sclerotic thickening of the peritoneal membrane leading to bowel obstruction (1)(2)(3)(4). Patients develop gastrointestinal (GI) symptoms with reduced appetite and weight loss (5).…”