Tastuo Hosoya | PubMed Health

PubMed2002

High-transport membrane is a risk factor for encapsulating peritoneal sclerosis developing after long-term continuous ambulatory peritoneal dialysis treatment.

Increased peritoneal function has been suggested to be a risk factor for developing encapsulating peritoneal sclerosis (EPS); however, clinical evidence is scarce. The present study aimed to clarify the specific character of peritoneal function in patients who developed EPS after withdrawal from peritoneal dialysis (PD). We studied 12 patients who developed EPS after PD withdrawal [(EPS group) mean PD duration: 109 months; mean period of EPS development: 7.0 months after withdrawal] and 128 patients who did not develop EPS (non EPS group). All 140 patients were withdrawn from continuous ambulatory peritoneal dialysis (CAPD) and were observed for the following 24 months. Based on the records of the annual peritoneal equilibration tests (PETs), we analyzed (1) the patients' dialysate-to-plasma (D/P) creatinine at various durations on PD, and (2) the accumulative appearance incidence of high-transport (HT) state of peritoneal membrane. The mean D/P creatinine in EPS group was significantly higher than that in the non EPS group in the course of PD from the 6th to the 10th year. The accumulative incidence of HT was significantly higher in the EPS group than in the non EPS group, indicating early development of HT membrane in EPS group. Early development of increased D/P creatinine, classified as HT state, was observed during certain periods on PD in patients who developed EPS after PD withdrawal. That finding may indicate that HT state of peritoneal membrane is an early marker for EPS, and that the PET is useful to detect patients at high risk of EPS.

Adult↗

PubMed2002

Risk factors and preventive measures for encapsulating peritoneal sclerosis--Jikei experience 2002.

A growing incidence of encapsulating peritoneal sclerosis (EPS) has been reported recently in Japan, and it is now urgent to establish preventive measures against EPS development. In the present paper, we describe our observational results regarding the risk of EPS development and the characteristic features of patients with EPS, in terms of peritoneal morphology and peritoneal function as determined by peritoneal equilibration test. The ongoing working protocol for EPS prevention at Jikei University Hospital is also discussed. Our findings have revealed that long-term continuous ambulatory peritoneal dialysis (CAPD) is a risk factor for EPS development after transfer to hemodialysis from peritoneal dialysis (PD), and that, in most patients with EPS, peritoneal function is characterized by a longstanding high-transport state. The striking alterations in peritoneal morphology between patients with EPS and those with simple long-term CAPD hyperplasia include, in EPS patients, a prominent thickening of the collagenous layer of the peritoneum with neoangiogenesis and myofibroblastic transformation. Based on our findings, we established a withdrawal protocol for long-term CAPD patients, with the goal of preventing EPS. Those who have been on PD treatment for more than 72 months with high-transport state are candidates for withdrawal from PD, with performance of peritoneal lavage thereafter for a certain period of time. The clinical benefit of post-PD lavage has not yet been determined; however, the maneuver could be precluded in patients at low risk of EPS, because it was found that some patients can recover to average transport state during the period of PD withdrawal. Patients who remain high transporters with inflammatory reaction might require pharmacologic intervention, including prednisolone therapy. Further observations are required to validate our approach.

Adult↗