Risk Factors for Encapsulating Peritoneal Sclerosis in Long‐Term Peritoneal Dialysis: A Retrospective Observational Study

Abstract

Encapsulating peritoneal sclerosis (EPS) is a serious complication that occurs in patients with long-term peritoneal dialysis (PD). Investigation of risk factors that contribute to EPS in patients on long-term PD therapy is needed. In a retrospective, observational study, data were collected for 107 patients treated with PD therapy for more than 5 years. Fifty cases of EPS were compared with 57 cases of non-EPS. To evaluate the impact of PD-associated peritonitis in EPS, univariate and multivariate logistic regression models were applied. Episodes of peritonitis, number of peritonitis episodes and the duration of peritonitis were included as explanatory variables in addition to previously reported risk factors. D/P Cr and serum β2MG levels in the EPS and non-EPS groups were: 0.82 ± 0.10 and 0.67 ± 0.12 (P < 0.01), and 33.8 ± 8.54 and 29.2 ± 8.18 mg/L (P < 0.01), respectively. Episodes of peritonitis, number of peritonitis episodes and the duration of peritonitis was 68% and 42% (P < 0.01), 1.80 ± 2.19 and 0.75 ± 1.07 times (P < 0.01), and 18.1 ± 15.3 and 10.2 ± 4.90 days (P < 0.01), in the EPS and non-EPS groups, respectively. Furthermore, multivariate logistic regression models demonstrated that both D/P Cr and the duration of peritonitis were independently associated with EPS (P < 0.01 and P < 0.05, respectively). In patients on long-term PD therapy, D/P Cr and the duration of peritonitis are independently associated with EPS. Earlier treatment to promote an early recovery from PD-associated peritonitis could be critical in preventing EPS.

33 Years of Peritoneal Dialysis‐Associated Peritonitis: A Single‐Center Study in Japan

“…Further, largely known drug‐resistant microorganisms, such as MRSA, MRSE and fungi, tended to result in earlier PD cessation. As previously reported, a longer duration of peritonitis might contribute to the development of EPS .…”

Risk factors for encapsulating peritoneal sclerosis: Analysis of a 36‐year experience in a University Hospital

“…It is thought that EPS development becomes higher when total duration of peritonitis is over 36 days. We have previously reported, that in patients on long‐term PD therapy (over 60 months), the duration of peritonitis was independently associated with the development of EPS . Our data revealed that the duration of peritonitis was independently associated with the development of EPS regardless of PD duration.…”

“…'Recovery from peritonitis' was defined as being present if the above detailed criteria resolved. In addition, 'the duration of peritonitis' was defined as the period from diagnosis to recovery of peritonitis . Furthermore, 'total duration of peritonitis' was defined as the sum of 'the duration of peritonitis'.…”

“…However, others found that most PD patients do not experience EPS even if they have several history of peritonitis . We have previously reported, that in patients on long‐term PD therapy (over 60 months), dialysate/plasma creatinine ratio (D/P Cr) and the duration of peritonitis, defined by period between onset and resolution of peritonitis, rather than with or without a history of peritonitis, were independently associated with the development of EPS . However, we did not consider risk factors for EPS development in patients on PD therapy less than 60 months.…”

Peritonitis-induced peritoneal injury models for research in peritoneal dialysis review of infectious and non-infectious models

“…Third, peritonitis presents a risk for the development of encapsulating peritoneal sclerosis (EPS) [6]. The duration of peritonitis is independently associated with EPS [7]. In particular, fungal and Pseudomonas infections put patients at a higher risk for the development of EPS [8].…”