Sclerosing Obstructive Peritonitis After Continuous Ambulatory Peritoneal Dialysis

Bradley, J. Andrew; McWhinnie, D. L.; Hamilton, David; Starnes, Fletcher H.; Macpherson, Stuart; Seywright, Morag; Briggs, J. D.; Junor, B. J. R.

doi:10.1016/s0140-6736(83)90106-x

Cited by 80 publications

(41 citation statements)

References 3 publications

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“…Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication in patients on PD, in which the peritoneum becomes progressively thickened and scarred, enclosing the bowel in fibrous tissue. Clinically, the patients present with recurrent small bowel obstruction, bloodstained dialysis effluent or ascites, and/or malnutrition (1,2). The incidence in case series of PD patients is approximately 1% to 3% and increases with length of time on PD, especially more than 5 yr (3)(4)(5).…”

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confidence: 99%

Assessing the Validity of an Abdominal CT Scoring System in the Diagnosis of Encapsulating Peritoneal Sclerosis

Tarzi

Lim²,

Moser³

et al. 2008

Clinical Journal of the American Society of Nephrology

118

122

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Background and objectives: Encapsulating peritoneal sclerosis (EPS) is a severe peritoneal fibrotic reaction in patients on long-term peritoneal dialysis (PD). The early clinical features may be nonspecific. The purpose of the study is to assess the reliability and diagnostic utility of abdominal CT scanning in the diagnosis of EPS.Design, setting, participants, & measurements: Abdominopelvic CT scans of 27 patients diagnosed with EPS on clinical and radiologic grounds in our unit from 1997 to 2006 were retrospectively analyzed. In addition, 35 control CT scans were scored: 15 from hemodialysis patients (HD controls) and 20 from patients on PD (PD controls). Scans were anonymized and scored independently by three radiologists.Results: Inter-rater agreement was moderate to very good (kappa ‫؍‬ 0.40 to 0.75) for peritoneal calcification, bowel distribution, bowel wall thickening, and bowel dilation but poorer for loculation of ascites and peritoneal thickening. There was a strongly significant difference between the total CT scan scores at EPS diagnosis and controls (P < 0.00001). Each individual parameter also showed significant differences between EPS and controls (P < 0.006). Bowel tethering and peritoneal calcification were the most specific parameters, and. loculation was the least discriminatory parameter. Interestingly, prediagnostic scans a median of 1.5 yr before EPS diagnosis were normal or near-normal in 9 of 13 EPS patients.Conclusions: CT scanning is a valid and reliable adjunct to the diagnosis of EPS but may not be useful as a screening tool, as the prediagnostic scans did not show abnormalities in many patients who subsequently developed EPS.

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mentioning

confidence: 99%

Assessing the Validity of an Abdominal CT Scoring System in the Diagnosis of Encapsulating Peritoneal Sclerosis

Tarzi

Lim²,

Moser³

et al. 2008

Clinical Journal of the American Society of Nephrology

118

122

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“…An advanced form of peritoneal sclerosis, encapsulating peritoneal sclerosis (EPS), is an uncommon but serious complication in long-term CAPD patients [15][16][17].…”

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confidence: 99%

Short-Term Biological Effects of a New and Less Acidic Fluid for Peritoneal Dialysis

Matsumoto

Sato²,

Miyai³

et al. 2003

Blood Purif

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Background: Conventional peritoneal dialysates are potentially bioincompatible and seem to be a causative factor for peritoneal sclerosis. Recent studies demonstrated that a new type of dialysate has a positive long-term clinical effect on dialysis patients. Methods: In this study, to elucidate the short-term biological effects of a newly developed dialysate of higher pH on the peritoneal membrane, we assessed macrophage proportions and several markers (inflammatory cytokines, cancer antigen 125 (CA125) and albumin) in spent dialysates before and 2 weeks after the change to the new fluid from a conventional fluid. Results: We found that the use of the new dialysate decreased intraperitoneal levels of inflammatory cytokines, CA125 and albumin associated with the decrease of macrophage populations in dialysis effluents. Conclusion: These observations suggest that a new and less acidic fluid reduces pro-inflammatory potential in the peritoneum, and thus affords better preservation of peritoneal membrane integrity in uremic patients on peritoneal dialysis.

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“…Peritonitis: Peritonitis episodes have long been considered to be a risk factor for EPS development [8,56,57]. In particular peritonitis caused by pseudomonas sp, staphylococcus aureus, haemophilus, or fungal organisms has been implicated in EPS [58,59].…”

Section: Duration Of Pdmentioning

confidence: 99%

Encapsulating Peritoneal Sclerosis: Case report and Current Status

Issad¹

2017

Arch Clin Nephrol

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Encapsulating peritoneal sclerosis (EPS), is a rare but devastating complication of long-term peritoneal dialysis (PD) with a high mortality rate. The incidence is between 0.5 and 3.3%, decreasing with time. EPS is defi ned as a clinical syndrome with major signs of gastrointestinal obstruction, infl ammatory parameters, radiological and macroscopic changes. Duration of treatment and cessation of PD are the main risk for development of EPS: about 75% of EPS occurred in patients transferred on hemodialysis or in the two years after kidney transplantation. Morphological alterations are disappearance of mesothelial layer, sub-mesothelial fi brosis, interstitial sclerosis and vasculopathy, ultrafi ltration failure, fast transport status of the peritoneal membrane, and loss of sodium sieving are the most predicting functional abnormalities. Some biomarkers could be found in the peritoneal effl uent. The pathophysiology is probably a consequence of a multiple-hit process in which expression of growth factors and cytokines play a role. Medical strategies (corticosteroids, immunosuppressive drugs, tamoxifen) in association with parenteral nutrition and/or surgery (enterolysis) are discussed. Prevention is the use of physiological peritoneal solutions, icodextrine instead of high glucose concentration solution, and peritoneal lavage after peritoneal dialysis cessation for any reason.

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Sclerosing Obstructive Peritonitis After Continuous Ambulatory Peritoneal Dialysis

Cited by 80 publications

References 3 publications

Assessing the Validity of an Abdominal CT Scoring System in the Diagnosis of Encapsulating Peritoneal Sclerosis

Assessing the Validity of an Abdominal CT Scoring System in the Diagnosis of Encapsulating Peritoneal Sclerosis

Short-Term Biological Effects of a New and Less Acidic Fluid for Peritoneal Dialysis

Encapsulating Peritoneal Sclerosis: Case report and Current Status

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