Encapsulating peritoneal sclerosis: incidence, predictors, and outcomes

Abstract

Encapsulating peritoneal sclerosis is a complication of peritoneal dialysis characterized by persistent, intermittent, or recurrent adhesive bowel obstruction. Here we examined the incidence, predictors, and outcomes of encapsulating peritoneal sclerosis (peritoneal fibrosis) by multivariate logistic regression in incident peritoneal dialysis patients in Australia and New Zealand. Matched case-control analysis compared the survival of patients with controls equivalent for age, gender, diabetes, and time on peritoneal dialysis. Of 7618 patients measured over a 13-year period, encapsulating peritoneal sclerosis was diagnosed in 33, giving an incidence rate of 1.8/1000 patient-years. The respective cumulative incidences of peritoneal sclerosis at 3, 5, and 8 years were 0.3, 0.8, and 3.9%. This condition was independently predicted by younger age and the duration of peritoneal dialysis, but not the rate of peritonitis. Twenty-six patients were diagnosed while still on peritoneal dialysis. Median survival following diagnosis was 4 years and not statistically different from that of 132 matched controls. Of the 18 patients who died, only 7 were attributed directly to peritoneal sclerosis. Our study shows that encapsulating peritoneal sclerosis is a rare condition, predicted by younger age and the duration of peritoneal dialysis. The risk of death is relatively low and not appreciably different from that of competing risks for mortality in matched dialysis control patients.

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.…”

American Society of Nephrology Quiz and Questionnaire 2012

“…EPS is a rare but potentially devastating complication of PD (8). Recent large prospective cohort studies from Australia, New Zealand, and Scotland suggest that the 8-year cumulative incidence in patients undergoing PD ranges from 4% to 8% (9,10). Although peritoneal fibrosis is common in patients treated with PD, a diagnosis of EPS requires the clinical or radiologic/anatomic evidence for both peritoneal sclerosis and intestinal encapsulation (9).…”

Review of the Literature and Description of a Case of Sclerosing Encapsulating Peritonitis Requiring Home Parenteral Nutrition

“…The classic beta blocker that was associated with SEP is practolol in 1974 [13], being withdrawn from the market in 1975. Since then many case reported with other beta blockers like atenolol propranolol, timolol, metoprolol and sotalol [3,21]. Karla et al [3] described 2 patients who were receiving propranolol for 2 years and 2 months respectively and both developed SEP. Their doses were 320 mg and 80mg day, showing that the development of SEP is independent of the dose.…”