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

Abstract

Both the longer duration of peritonitis and higher D/P Cr, as well as the longer PD duration, were risk factors for EPS development. Furthermore, use of biocompatible PD fluid contributed to the decrease in EPS development.

Biocompatibility of a new PD solution for Japan, Reguneal™, measured as in vitro proliferation of fibroblasts

“…On the basis of these results, the enhanced biocompatibility of Reguneal™ might ameliorate PDF-induced peritoneal membrane remodeling, and lessen the frequency and severity of peritoneal membrane failure. There is some support for this possibility in a recent landmark study from Japan [5]. This study showed that the decline in EPS was most strongly predicted by the use of more biocompatible PDFs, rather any practice around early and planned discontinuation [42,43].…”

“…As a result, there was widespread call to action in Japan for peritoneal protection during PD, and the early and complete adoption of biocompatible PD fluids (PDFs) in routine clinical practice. Since that time, the incidence of EPS has decreased drastically [5][6][7], although anxiety persists reinforcing the culture of early and planned discontinuation on PD and other special cares [8][9][10]. While the main threat of EPS is historical, the quest for optimally biocompatible PDFs has been an important background activity in Japan, to ensure ongoing safe and effective products for practitioners and patients.…”

Encapsulating Peritoneal Sclerosis in Long-Termed Peritoneal Dialysis Patients

“…The observed risk of EPS after 5 years of PD has been reported to vary from 2.1% in Japan [ 13 ] to 6.4% in Australia [ 12 ] and 8.1% in Scotland [ 22 ]. It is well documented that many patients develop EPS when switched to HD [ 23 ]. These patients who changing modality to HD are difficult to follow up and some of them may develop EPS later.…”

“…A number of studies have emphasized the association between peritonitis related factors and EPS development [ 23 , 28 – 30 ]. In our study, the total peritonitis times, duration of peritonitis treatment, and fungus peritonitis were significantly different between the EPS and non-EPS groups.…”

Biocompatible Peritoneal Dialysis: The Target Is Still Way Off

“…Compared to first-generation PD fluids, administration of neutral pH, low GDP fluids resulted in higher CA125 effluent concentrations (Haas et al., 2003; Szeto et al., 2007), a putative marker of mesothelial cell viability and lower hyaluronic acid and procollagen peptide concentrations, suggesting improved peritoneal membrane integrity (Williams et al., 2004). A declining incidence of encapsulating peritoneal sclerosis has been associated with low GDP fluid usage (Nakao et al., 2017). Residual renal function, a major predictor of patient outcome, was better preserved (Kim et al., 2008; Haag-Weber et al., 2010; Johnson et al., 2012b).…”