Risk factors of severe peritoneal sclerosis in chronic peritoneal dialysis patients

Abstract

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.

Significant Decreasing Incidence of Encapsulating Peritoneal Sclerosis in the Dutch Population of Peritoneal Dialysis Patients

“…Most studies have consistently identified increasing PD duration as a key risk factor for development of EPS (Table 1) (11,12,18,(21)(22)(23)(24)(25)(26)(27). Other parameters that have been identified in at least 1 study to be possible risk factors for EPS include higher dialysate glucose exposure, use of conventional PD solutions (as opposed to biocompatible PD solutions), peritonitis (frequent, severe, or prolonged), younger age (presumably because of lower competing risk of death), abdominal surgery, β-blocker use, icodextrin use, kidney transplantation, UF failure, and higher peritoneal solute transport rate (PSTR) (13,(20)(21)(22)25,(28)(29)(30)(31)(32). However, these data have been too imprecise and/or inconsistent to be considered reliable at this time.…”

Length of Time on Peritoneal Dialysis and Encapsulating Peritoneal Sclerosis — Position Paper for ISPD: 2017 Update

“…Other parameters that have been identified in at least 1 study to be possible risk factors for EPS include higher dialysate glucose exposure, use of conventional PD solutions (as opposed to biocompatible PD solutions), peritonitis (frequent, severe, or prolonged), younger age (presumably because of lower competing risk of death), abdominal surgery, β-blocker use, icodextrin use, kidney transplantation, UF failure, and higher peritoneal solute transport rate (PSTR) (13,(20)(21)(22)25,(28)(29)(30)(31)(32). However, these data have been too imprecise and/or inconsistent to be considered reliable at this time.…”

“…Most studies have consistently identified increasing PD duration as a key risk factor for development of EPS (Table 1) (11,12,18,(21)(22)(23)(24)(25)(26)(27). Other parameters that have been identified in at least 1 study to be possible risk factors for EPS include higher dialysate glucose exposure, use of conventional PD solutions (as opposed to biocompatible PD solutions), peritonitis (frequent, severe, or prolonged), younger age (presumably because of lower competing risk of death), abdominal surgery, β-blocker use, icodextrin use, kidney transplantation, UF failure, and higher peritoneal solute transport rate (PSTR) (13,(20)(21)(22)25,(28)(29)(30)(31)(32).…”

Encapsulating Peritoneal Sclerosis in Long-Termed Peritoneal Dialysis Patients

“…However, recent studies have found that the prevalence of EPS is increasing compared to previous reports. An Italian study revealed an EPS prevalence of 2.8% [ 20 ] and an Iranian center showed the prevalence of EPS at 2.6% [ 21 ]. The rise in the prevalence of EPS in recent studies reflected both a longer duration of PD exposure and higher awareness of EPS.…”

“…Similarly, Johnson et al showed no association between peritonitis frequency and EPS risk [ 15 ]. Recently, in Iran, a study found both peritonitis rate and total peritonitis episodes were not significantly different between EPS and control groups in regression analysis [ 21 ]. In our study, we found that PD duration is the only strong independent factor associated with EPS.…”