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Guo J, Liu R, Peng Y, Yi C, Wu H, Ye H, Lin J, Diao X, Huang F, Mao H, Guo Q, Yang X. The centre-calculated cutoff value is better for identifying fast peritoneal solute transfer of patients on peritoneal dialysis than the traditional value: a retrospective cohort study. Clin Kidney J 2023; 16:2023-2031. [PMID: 37915941 PMCID: PMC10616441 DOI: 10.1093/ckj/sfad197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Indexed: 11/03/2023] Open
Abstract
Background The mean 4-h dialysate to plasma ratio of creatinine (4-h D/Pcr) is a vital cutoff value for recognizing the fast peritoneal solute transfer rate (PSTR) in patients on peritoneal dialysis (PD); however, it shows a noticeable centre effect. We aimed to investigate our centre-calculated cutoff value (CCV) of 4-h D/Pcr and compare it with the traditional cutoff value (TCV) (0.65). Methods In this study, we enrolled incident PD patients at our centre from 2008 to 2019, and divided them into fast or non-fast PSTR groups according to baseline 4-h D/Pcr-based CCV or TCV. We compared the efficiency of the fast PSTR recognized by two cutoff values in predicting mortality, ultrafiltration (UF) insufficiency and technical survival. Results In total, 1905 patients were enrolled, with a mean 4-h D/Pcr of 0.71 ± 0.11. Compared with TCV (0.65), CCV (0.71) showed superiority in predicting mortality of PD patients [hazard ratio (HR) 1.27, 95% confidence interval (CI) 1.02-1.59 vs HR 1.24, 95% CI 0.97-1.59]. The odds ratio (OR) of the fast PSTR in centre classification was slightly higher than traditional classification in predicting UF insufficiency (OR 1.67, 95% CI 1.25-2.24 vs OR 1.60, 95% CI 1.15-2.22). Additionally, the restricted cubic splines 4-h D/Pcr has an S-shaped association with mortality and UF insufficiency, and the inflection points of 4-h D/Pcr were 0.71 (equal to CCV). Conclusions The CCV of 4-h D/Pcr for identifying fast PSTR was 0.71. It was superior to TCV in predicting mortality and UF insufficiency.
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Affiliation(s)
- Jing Guo
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Ruihua Liu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Yuan Peng
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Haishan Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Jianxiong Lin
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Xiangwen Diao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Fengxian Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Qunying Guo
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
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2
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Li D, Li Y, Zeng H, Wu Y. Risk factors for Encapsulating Peritoneal Sclerosis in patients undergoing peritoneal dialysis: A meta-analysis. PLoS One 2022; 17:e0265584. [PMID: 35312717 PMCID: PMC8936465 DOI: 10.1371/journal.pone.0265584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/05/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
Encapsulating Peritoneal Sclerosis (EPS) is the most serious complication of long-term peritoneal dialysis (PD), which considerably reduces the patient’s quality of life, leading to patients discontinuing PD. Considering these negative effects, it is necessary to systematically review and determine the risk factors of EPS.
Methods
The PubMed, Embase, Web of Science, Cochrane Library, and China Biology Medicine (CBM) were searched from their inception to January 1st, 2022, and the bibliographies from the citations of relevant articles were manually searched. The ROBINS-I (Risk of Bias in Non-randomized studies of Interventions) tool was used to evaluate the risk of bias of included studies.
Results
Ten studies involving 12595 participants were included in this meta-analysis. The results revealed that a younger age at PD onset (MD = -7.70, 95% CI, -11.53~-3.86), a higher transporter (MD = 0.13, 95% CI, 0.09~0.18), a longer PD duration (SMD = 1.15, 95% CI, 0.68~1.61), a longer peritonitis duration (MD = 12.66, 95% CI, 3.85~21.47), and history of glomerulonephritis (OR = 1.42, 95% CI, 1.02~1.97) were significant risk factors for EPS. However, sex, use of icodextrin, the number of peritonitis episodes, and history of multicystic kidney disease did not affect the risk of EPS.
Conclusions
This review provides a scientific basis for further understanding the etiology of PD-related EPS and improving prevention strategies. More high-quality studies are necessary to validate this paper’s findings.
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Affiliation(s)
- Dashan Li
- Department of Nephropathy, the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Yuanyuan Li
- Department of Nephropathy, the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Hanxu Zeng
- Department of Nephropathy, the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Yonggui Wu
- Department of Nephropathy, the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
- * E-mail:
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3
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Reis M, Gomes AM, Santos C, Lopes D, Fernandes JC. Encapsulating peritoneal sclerosis: from early diagnosis to successful kidney transplantation. J Bras Nefrol 2022; 44:587-591. [PMID: 33891672 PMCID: PMC9838658 DOI: 10.1590/2175-8239-jbn-2021-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 01/26/2023] Open
Abstract
Encapsulating peritoneal sclerosis is an uncommon but serious complication of peritoneal dialysis. In most cases, the symptoms appear after peritoneal dialysis withdrawal, which hampers its diagnosis. We present the case of a 44-years-old Caucasian male who had been on peritoneal dialysis for 6 years and 3 months and was switched to hemodialysis due to ultrafiltration failure. During his last months on peritoneal dialysis, he developed anorexia and asthenia, which were initially attributed to dialysis inadequacy. After hemodialysis induction, the patient developed abdominal pain, increased abdominal volume, obstipation alternating with diarrhea, and weight loss. Computed tomography showed de novo ascites. A diagnosis of early encapsulating peritoneal sclerosis was considered, and treatment was promptly initiated with nutritional support, oral prednisolone, and tamoxifen for one year. The patient progressed with resolution of the symptoms. One month after the end of the treatment, he underwent a successful kidney transplant and remain without any major intercurrences. A high level of clinical suspicion is crucial for the early diagnosis of encapsulating peritoneal sclerosis as the disease can be fatal in advanced stages. This case highlights that with early treatment, kidney transplantation can be successfully performed after an episode of encapsulating peritoneal sclerosis.
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Affiliation(s)
- Marina Reis
- Centro Hospitalar Vila Nova de Gaia/Espinho, Departamento de Nefrologia, Vila Nova de Gaia, Portugal
| | - Ana Marta Gomes
- Centro Hospitalar Vila Nova de Gaia/Espinho, Departamento de Nefrologia, Vila Nova de Gaia, Portugal
| | - Clara Santos
- Centro Hospitalar Vila Nova de Gaia/Espinho, Departamento de Nefrologia, Vila Nova de Gaia, Portugal
| | - Daniela Lopes
- Centro Hospitalar Vila Nova de Gaia/Espinho, Departamento de Nefrologia, Vila Nova de Gaia, Portugal
| | - João Carlos Fernandes
- Centro Hospitalar Vila Nova de Gaia/Espinho, Departamento de Nefrologia, Vila Nova de Gaia, Portugal
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4
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Gaied H, Bacha MM, Jaziri F, Ounissi M, Aoudia R, Jerbi M, Hedri H, Goucha R, Benabdallah T. Encapsulating Peritoneal Sclerosis after kidney Transplantation: Success of Medical Treatment. Indian J Nephrol 2021; 31:194-196. [PMID: 34267447 PMCID: PMC8240943 DOI: 10.4103/ijn.ijn_329_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 11/27/2019] [Indexed: 11/08/2022] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is an infrequent but serious complication of long-term peritoneal dialysis (PD). EPS may become clinically apparent when patients are on PD (classical EPS) or after undergoing kidney transplantation (post-transplantation EPS). This presentation of EPS seems to occur shortly after kidney transplantation in former PD patients. In this report, we present our experience in our first case of patient diagnosed with EPS after kidney transplantation.
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Affiliation(s)
- Hanene Gaied
- Department of Nephrology, Mongi Slim Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, Tunis, Tunisia.,Laboratory of Histopathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mohamed Mongi Bacha
- Faculty of Medicine of Tunis, Tunis, Tunisia.,Department of Internal Medicine « A », Charles Nicolle Hospital, Tunis, Tunisia.,Laboratory of Histopathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Fatima Jaziri
- Faculty of Medicine of Tunis, Tunis, Tunisia.,Department of Internal Medicine « A », Charles Nicolle Hospital, Tunis, Tunisia.,Laboratory of Histopathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mondher Ounissi
- Faculty of Medicine of Tunis, Tunis, Tunisia.,Department of Internal Medicine « A », Charles Nicolle Hospital, Tunis, Tunisia.,Laboratory of Histopathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Raja Aoudia
- Faculty of Medicine of Tunis, Tunis, Tunisia.,Department of Internal Medicine « A », Charles Nicolle Hospital, Tunis, Tunisia.,Laboratory of Histopathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mouna Jerbi
- Department of Nephrology, Mongi Slim Hospital, Tunis, Tunisia.,Department of Internal Medicine « A », Charles Nicolle Hospital, Tunis, Tunisia.,Laboratory of Histopathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hafedh Hedri
- Faculty of Medicine of Tunis, Tunis, Tunisia.,Department of Internal Medicine « A », Charles Nicolle Hospital, Tunis, Tunisia.,Laboratory of Histopathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Rim Goucha
- Department of Nephrology, Mongi Slim Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, Tunis, Tunisia.,Laboratory of Histopathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Taieb Benabdallah
- Faculty of Medicine of Tunis, Tunis, Tunisia.,Department of Internal Medicine « A », Charles Nicolle Hospital, Tunis, Tunisia.,Laboratory of Histopathology, Charles Nicolle Hospital, Tunis, Tunisia
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5
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Tawada M, Ito Y, Banshodani M, Yamashita M, Shintaku S, Sun T, Suzuki Y, Kinashi H, Kubo Y, Ando M, Yamaguchi M, Katsuno T, Mizuno M, Kawanishi H. Vasculopathy plays an important role during the development and relapse of encapsulating peritoneal sclerosis with conventional peritoneal dialysis solutions. Nephrol Dial Transplant 2020; 36:1519-1526. [DOI: 10.1093/ndt/gfaa073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background
Encapsulating peritoneal sclerosis (EPS) is an uncommon but life-threatening complication of peritoneal dialysis (PD) therapy. The causative factors of EPS remain unclear. Pathological studies of the peritoneum affected by EPS and relationships with clinical factors including PD solutions remain lacking. The objective of this study was to examine peritoneal samples from EPS patients and to identify the associations of peritoneal pathology with different clinical factors.
Methods
Peritoneal specimens were obtained at the time of surgical enterolysis in Tsuchiya General Hospital from 1993 to 2016. A total of 223 PD patients were enrolled and analyzed. Tissues were fixed with formalin and processed with hematoxylin and eosin and Masson’s trichrome staining, as well as immunohistochemical staining for CD31 and CD68.
Results
Evaluations could be made in 174 patients who received surgical enterolysis. Conventional or pH-neutral low-glucose degradation product PD solutions were utilized during PD treatment. The conventional PD solution group showed less angiogenesis (P = 0.013) but more severe vasculopathy, in the form of a lower ratio of luminal diameter to vessel diameter (L/V ratio) (P < 0.001) in association with longer PD treatment. Multivariate Cox proportional hazard models revealed that L/V ratio (per 0.1 increase, hazard ratio = 0.88, 95% confidence interval 0.77–0.99, P = 0.047) was significantly associated with a lower incidence of EPS relapse. In contrast, most of the cases in the pH-neutral solution group showed milder vasculopathy.
Conclusions
The pathology of EPS differed between conventional and pH-neutral solution groups. Vasculopathy was related to the development and relapse of EPS in the conventional solution group.
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Affiliation(s)
- Mitsuhiro Tawada
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Masataka Banshodani
- Department of Surgery and Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Masahiro Yamashita
- Department of Surgery and Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Sadanori Shintaku
- Department of Surgery and Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Ting Sun
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Suzuki
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Kinashi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Yoko Kubo
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiko Ando
- Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Makoto Yamaguchi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Takayuki Katsuno
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Masashi Mizuno
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Kawanishi
- Department of Surgery and Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
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6
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Ribeiro BHD, Takenaka VS, Borges FS, Andrade TFD, Lessa SB, Mancero JMP, Noronha IL, David AI. Encapsulating Peritoneal Sclerosis in a kidney transplant recipient - Case Report. J Bras Nefrol 2020; 42:370-374. [PMID: 32406486 PMCID: PMC7657044 DOI: 10.1590/2175-8239-jbn-2019-0193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/22/2019] [Indexed: 11/22/2022] Open
Abstract
Encapsulating Peritoneal Sclerosis (EPS) is a severe and rare condition frequently associated with peritoneal dialysis, characterized by bowel obstruction, with lethal consequences in 20% of the patients. The disease presents as a mass of fibrous tissue encapsulating visceral organs that may potentially compromise digestive tract function. This report describes the case of a patient under peritoneal dialysis (PD) due to chronic kidney disease secondary to focal segmental glomerulosclerosis diagnosed with EPS. The patient had undergone two living-donor kidney transplant procedures. Surgical techniques and clinical measures employed to unravel bowel obstruction are described, which have been shown to ameliorate EPS secondary complications. Parenteral nutrition has significantly contributed to afford adequate nutrition, improving tissue healing as well as serum protein levels, vitamins and electrolytes. Therapy with tamoxifen and sodium thiosulfate effectively delayed the development of EPS.
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Affiliation(s)
- Bruno Henrique Dantas Ribeiro
- Hospital Beneficência Portuguesa de São Paulo, Equipe de Nefrologia e Transplante de Rim e Rim-Pâncreas, São Paulo, SP, Brasil
| | - Vanessa Suemi Takenaka
- Hospital Beneficência Portuguesa de São Paulo, Instituto de Gastrocirurgia Avançada, Programa de Cirurgia Geral e Aparelho Digestivo, São Paulo, SP, Brasil
| | - Felipe Sbrolini Borges
- Hospital Beneficência Portuguesa de São Paulo, Instituto de Gastrocirurgia Avançada, Programa de Cirurgia Geral e Aparelho Digestivo, São Paulo, SP, Brasil.,Hospital Beneficência Portuguesa de São Paulo, Instituto de Gastrocirurgia Avançada, Programa de Transplante de Fígado, São Paulo, SP, Brasil
| | - Thales Franco de Andrade
- Hospital Beneficência Portuguesa de São Paulo, Instituto de Gastrocirurgia Avançada, Programa de Cirurgia Geral e Aparelho Digestivo, São Paulo, SP, Brasil
| | - Sibele Braga Lessa
- Hospital Beneficência Portuguesa de São Paulo, Equipe de Nefrologia e Transplante de Rim e Rim-Pâncreas, São Paulo, SP, Brasil
| | - Jorge Marcelo Padilla Mancero
- Hospital Beneficência Portuguesa de São Paulo, Instituto de Gastrocirurgia Avançada, Programa de Cirurgia Geral e Aparelho Digestivo, São Paulo, SP, Brasil.,Hospital Beneficência Portuguesa de São Paulo, Instituto de Gastrocirurgia Avançada, Programa de Transplante de Fígado, São Paulo, SP, Brasil
| | - Irene L Noronha
- Hospital Beneficência Portuguesa de São Paulo, Equipe de Nefrologia e Transplante de Rim e Rim-Pâncreas, São Paulo, SP, Brasil.,Universidade de São Paulo, Faculdade de Medicina, Laboratório de Nefrologia Celular, Genética e Molecular, São Paulo, SP, Brasil
| | - André Ibrahim David
- Hospital Beneficência Portuguesa de São Paulo, Instituto de Gastrocirurgia Avançada, Programa de Cirurgia Geral e Aparelho Digestivo, São Paulo, SP, Brasil.,Hospital Beneficência Portuguesa de São Paulo, Instituto de Gastrocirurgia Avançada, Programa de Transplante de Fígado, São Paulo, SP, Brasil
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7
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Jagirdar RM, Bozikas A, Zarogiannis SG, Bartosova M, Schmitt CP, Liakopoulos V. Encapsulating Peritoneal Sclerosis: Pathophysiology and Current Treatment Options. Int J Mol Sci 2019; 20:ijms20225765. [PMID: 31744097 PMCID: PMC6887950 DOI: 10.3390/ijms20225765] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 12/18/2022] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a life-threatening complication of long-term peritoneal dialysis (PD), which may even occur after patients have switched to hemodialysis (HD) or undergone kidney transplantation. The incidence of EPS varies across the globe and increases with PD vintage. Causative factors are the chronic exposure to bioincompatible PD solutions, which cause long-term modifications of the peritoneum, a high peritoneal transporter status involving high glucose concentrations, peritonitis episodes, and smoldering peritoneal inflammation. Additional potential causes are predisposing genetic factors and some medications. Clinical symptoms comprise signs of intestinal obstruction and a high peritoneal transporter status with incipient ultrafiltration failure. In radiological, macro-, and microscopic studies, a massively fibrotic and calcified peritoneum enclosed the intestine and parietal wall in such cases. Empirical treatments commonly used are corticosteroids and tamoxifen, which has fibrinolytic properties. Immunosuppressants like azathioprine, mycophenolate mofetil, or mTOR inhibitors may also help with reducing inflammation, fibrin deposition, and collagen synthesis and maturation. In animal studies, N-acetylcysteine, colchicine, rosiglitazone, thalidomide, and renin-angiotensin system (RAS) inhibitors yielded promising results. Surgical treatment has mainly been performed in severe cases of intestinal obstruction, with varying results. Mortality rates are still 25–55% in adults and about 14% in children. To reduce the incidence of EPS and improve the outcome of this devastating complication of chronic PD, vigorous consideration of the risk factors, early diagnosis, and timely discontinuation of PD and therapeutic interventions are mandatory, even though these are merely based on empirical evidence.
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Affiliation(s)
- Rajesh M. Jagirdar
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (R.M.J.); (A.B.)
| | - Andreas Bozikas
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (R.M.J.); (A.B.)
| | - Sotirios G. Zarogiannis
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.G.Z.); (M.B.); (C.P.S.)
- Department of Physiology, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Maria Bartosova
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.G.Z.); (M.B.); (C.P.S.)
| | - Claus Peter Schmitt
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.G.Z.); (M.B.); (C.P.S.)
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (R.M.J.); (A.B.)
- Correspondence: ; Tel.: +30-2310-994694
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8
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Barreto DL, Sampimon DE, Struijk DG, Krediet RT. Early Detection of Imminent Encapsulating Peritoneal Sclerosis: Free Water Transport, Selected Effluent Proteins, or Both? Perit Dial Int 2019; 39:83-89. [DOI: 10.3747/pdi.2017.00194] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 06/13/2018] [Indexed: 11/15/2022] Open
Abstract
Background No diagnostic tool or methodology is currently available for early detection of imminent encapsulating peritoneal sclerosis (EPS). The objective of this study was to investigate the predictive value of free water transport (FWT) and construct a panel of peritoneal effluent proteins for EPS alone or in combination with FWT. These parameters could be incorporated in the follow-up of peritoneal dialysis (PD) patients. Methods A case-control study, nested in a longitudinal PD patient cohort, was conducted. Time-specific areas under the receiver operating characteristic (ROC) curve were calculated for FWT and effluent biomarkers at a lag time up to 3 years before EPS diagnosis. Free water transport was combined with appearance rates (AR) of biomarkers to assess their clinical validity. Results Free water transport volume and AR of effluent bio-markers were investigated in 11 EPS patients and 34 long-term PD patients. Diagnostic performance was best for FWT (area under the curve [AUC] 0.94) followed by plasminogen activator inhibitor (PAI-1) AR. Throughout, diagnostic panels of FWT and AR of cancer antigen 125 (CA125), interleukin-6 (IL-6), or (PAI-1) yielded specificity estimates above 84%. The combination of FWT and PAI-1 AR identified the largest proportion of EPS patients at 1 year prior to diagnosis (sensitivity 100%, specificity 94%). Conclusion Measurement of FWT is simple and has the highest predictive value for imminent EPS. The addition of effluent biomarkers provides an all-round insight into the state of the peritoneum. Our data indicate that combining FWT with either PAI-1, CA125, or IL-6 has the highest specificity. This is required to avoid unnecessary discontinuation of PD treatment.
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Affiliation(s)
- Deirisa Lopes Barreto
- Division of Nephrology, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Denise E. Sampimon
- Division of Nephrology, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Dirk G. Struijk
- Division of Nephrology, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Dianet Foundation, Amsterdam-Utrecht, The Netherlands
| | - Raymond T. Krediet
- Division of Nephrology, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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9
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Tawada M, Hamada C, Suzuki Y, Sakata F, Sun T, Kinashi H, Katsuno T, Takei Y, Maruyama S, Honda K, Mizuno M, Ito Y. Effects of long-term treatment with low-GDP, pH-neutral solutions on peritoneal membranes in peritoneal dialysis patients. Clin Exp Nephrol 2018; 23:689-699. [DOI: 10.1007/s10157-018-1679-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/04/2018] [Indexed: 01/08/2023]
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10
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Brown EA, Bargman J, van Biesen W, Chang MY, Finkelstein FO, Hurst H, Johnson DW, Kawanishi H, Lambie M, de Moraes TP, Morelle J, Woodrow G. Length of Time on Peritoneal Dialysis and Encapsulating Peritoneal Sclerosis - Position Paper for ISPD: 2017 Update. Perit Dial Int 2018; 37:362-374. [PMID: 28676507 DOI: 10.3747/pdi.2017.00018] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/04/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Joanne Bargman
- University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Wim van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Ming-Yang Chang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Helen Hurst
- Central Manchester and Manchester Children's NHS Foundation Trust, Manchester, UK
| | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Hideki Kawanishi
- Tsuchiya General Hospital, Faculty of Medicine, Hiroshima University, Japan
| | - Mark Lambie
- Institute for Applied Clinical Sciences, Keele University, Stoke-on-Trent, UK
| | | | - Johann Morelle
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium, et Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
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11
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Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of peritoneal dialysis. In this review, we describe the clinical picture and histologic changes to the peritoneal membrane that are associated with EPS and provide an update on current diagnosis and management. We also discuss the recent studies that have suggested that the use of more biocompatible solutions containing lower concentrations of glucose degradation product that often are pH neutral in combination with a change in clinical practice (reducing glucose exposure and monitoring peritoneal membrane function) might ameliorate peritoneal degeneration, reduce the incidence of EPS, and minimize the severity of the disease.
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Affiliation(s)
- Helen Alston
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
| | - Stanley Fan
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK.
| | - Masaaki Nakayama
- Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine, Fukushima, Japan
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12
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Encapsulating Peritoneal Sclerosis in Peritoneal Dialysis Patients After Kidney Transplantation. Transplant Proc 2018; 50:160-164. [DOI: 10.1016/j.transproceed.2017.12.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/17/2017] [Accepted: 12/12/2017] [Indexed: 12/20/2022]
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13
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Significance of new membrane formation in peritoneal biopsies of peritoneal dialysis patients: a case–control study. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0115-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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14
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Ryckelynck JP, Béchade C, Bouvier N, Ficheux M, Hurault de Ligny B, Lobbedez T. La péritonite sclérosante et encapsulante. Nephrol Ther 2017; 13:211-219. [DOI: 10.1016/j.nephro.2017.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/16/2017] [Accepted: 01/21/2017] [Indexed: 01/11/2023]
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15
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Stuart S, Stott D, Goode A, Cash CJ, Davenport A. Can radiological assessment of abdominal computerized scans diagnose encapsulating peritoneal sclerosis in long-term peritoneal dialysis patients? Nephrology (Carlton) 2017; 22:19-24. [PMID: 26730546 DOI: 10.1111/nep.12718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/08/2015] [Accepted: 12/29/2015] [Indexed: 12/11/2022]
Abstract
AIM Encapsulating peritoneal sclerosis (EPS) is a rare but potentially devastating complication of long-term peritoneal dialysis (PD). Changes to the peritoneal membrane occur with duration of PD therapy. To determine the potential effect of prospective computerized tomography (CT) scanning, we reviewed the scans of patients who had developed EPS compared with those without EPS. METHODS We retrospectively compared CT scans that had been prospectively performed in a screening program for PD patients after 4 years of PD and compared scans from 18 patients with confirmed EPS and 26 vintage matched controls without EPS. Anonymized scans were reported independently by two blinded experienced radiologists. RESULTS Peritoneal thickening, calcification, bowel tethering, thickening and dilatation were significantly more commonly reported in the EPS group. Total combined radiological scores, also including septation within peritoneal fluid, were significantly higher in the EPS group and the greatest for those who died as a consequence of EPS. Simplified scoring based on presence or absence, then for a score of ≥3.0, gave a receiver operating characteristic value of 0.87 for EPS, with a sensitivity of 78% and specificity of 85%, respectively. Inter-observer agreement varied from poor to good, being the greatest for calcification and bowel dilatation and the lowest for peritoneal thickening. CONCLUSION CT scan reporting can differentiate EPS from peritoneal changes associated with duration of PD therapy. Severity of abnormalities was associated with clinical outcomes. However, inter-observer agreement varies with different radiological appearances, and future studies are required to determine weighting of radiological changes to provide prognostic information for clinicians and patients.
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Affiliation(s)
- Sam Stuart
- Department of Radiology, Royal Free Hospital, London, UK
| | - David Stott
- Faculty of Health and Human Sciences, University of Hertfordshire, Hatfield, UK
| | - Antony Goode
- Department of Radiology, Royal Free Hospital, London, UK
| | | | - Andrew Davenport
- UCL Center for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
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16
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Goodlad C, Davenport A. Does Peritoneal Protein Transport Increase with Peritoneal Dialysis Therapy Duration and Lead to Extracellular Water Overload in Peritoneal Dialysis Patients? Ther Apher Dial 2017; 21:79-87. [PMID: 28105770 DOI: 10.1111/1744-9987.12484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 01/10/2023]
Abstract
Faster peritoneal transport status has been associated with adverse outcomes for peritoneal dialysis (PD) patients. Peritoneal protein clearance, through large pores, may be a surrogate marker of local inflammation. We wished to determine whether peritoneal protein transport increased with PD duration or was associated with extracellular water (ECW) expansion. We studied the relationships between 4 h Dialysate (D)/Serum (S) protein and ECW excess, using multifrequency bioelectrical impedance assessments, in 103 PD patients with up to 4 years of prospectively collected peritoneal equilibrium test (PET) results. 4 h PET D/S total protein and creatinine ratios were stable over time (K-W test, P = 0.063 and P = 0.3357, respectively). The initial PET 4 h D/S creatinine and D/S total protein correlated with ECW excess (r = 0.33, P = 0.003, and r = 0.27, P = 0.019, respectively), but thereafter there was no association. CRP and albumin did not correlate with 4 h D/S creatinine or total protein. Serial 4 h D/S total protein and 4 h D/S creatinine correlated all time points (P < 0.001). At the start of PD therapy, over-hydration (ECW excess) was observed with higher 4 h D/S creatinine and 4 h D/S total protein ratios, suggesting initial exposure to PD fluids causes faster transport. Thereafter changes in peritoneal creatinine and total protein transport mirrored each other suggesting that similar factors lead to changes in both small and large pore transport, and there was no sustained increase in larger pore transport with therapy time.
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Affiliation(s)
- Cate Goodlad
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
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17
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Idei M, Tabe Y, Hamada C, Miyake K, Takemura H, Io H, Wakita M, Horii T, Tomino Y, Ohsaka A, Miida T. Pancreatic lipase activity in overnight effluent predicts high transport status in peritoneal dialysis patients. Clin Chim Acta 2016; 462:65-70. [PMID: 27531412 DOI: 10.1016/j.cca.2016.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 08/01/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Long-term peritoneal dialysis (PD) causes peritoneal morphological and functional changes, resulting in high transport status featuring increased peritoneal permeability. High transport status is diagnosed by peritoneal equilibration test (PET), a reliable but time-consuming method. We identifed a reliable biomarker in peritoneal effluent to predict high transport status in PD patients. METHODS We collected peritoneal effluent and serum from 33 PD patients and measured common laboratory test parameters. High transport status was determined by PET if the dialysate/plasma ratio of creatinine at 4h dwell (D/P Cr 4h) was ≥0.81. RESULTS There were significant correlations between D/P Cr 4h and some laboratory parameters in overnight effluent (pancreatic lipase activity, r=0.65, p<0.001; β2-microglobulin concentration, r=0.59, p<0.001; IL-6 concentration, r=0.53, p<0.001; and CA125 concentration, r=0.29, p=0.027). In a multivariate logistic regression analysis, the pancreatic lipase activity in overnight effluent was identified as an independent predictor of high transport status even after adjusting for age, PD duration, and glomerular filtration rate [OR=1.43 (95% CI: 1.11-1.83), p=0.005]. CONCLUSIONS The pancreatic lipase activity in overnight effluent is an independent predictor of high transport status in PD patients.
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Affiliation(s)
- Mayumi Idei
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan.
| | - Yoko Tabe
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Chieko Hamada
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kazunori Miyake
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Hiroyuki Takemura
- Department of Clinical Laboratory, Juntendo University Hospital, Hongo 3-1-1, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Hiroaki Io
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Mitsuru Wakita
- Department of Clinical Laboratory, Juntendo University Hospital, Hongo 3-1-1, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Takashi Horii
- Department of Clinical Laboratory, Juntendo University Hospital, Hongo 3-1-1, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yasuhiko Tomino
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Akimichi Ohsaka
- Department of Clinical Laboratory, Juntendo University Hospital, Hongo 3-1-1, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan
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18
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Nitsch D, Davenport A. Designing Epidemiology Studies to Determine the Incidence and Prevalence of Encapsulating Peritoneal Sclerosis (EPS). Perit Dial Int 2016; 35:678-82. [PMID: 26703844 DOI: 10.3747/pdi.2015.00186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The reported incidence and prevalence of encapsulating peritoneal sclerosis (EPS) varies markedly between North America, Europe, Japan, and Australia. Although this could reflect differences in clinical practice patterns and access to transplantation as there is no current test for early detection, and some patients may present many years after discontinuation of peritoneal dialysis (PD), there are concerns about under-reporting, particularly for those with milder forms. Currently, only PD vintage has been identified as a significant risk factor for developing EPS, although some patients can develop EPS within months of starting PD. As such, there is a need for epidemiological studies to determine the incidence and prevalence of EPS to allow for patient education and counselling in terms of dialysis modality choice and length of treatment. In addition, carefully designed epidemiological studies could potentially allow for the identification of risk factors and bio-markers that could then be used to identify patients at increased risk of developing EPS in the future. Typically, studies to date have been underpowered with inadequate longitudinal follow-up. We review the different types of epidemiological studies and provide information as to the number of patients to be recruited and the duration of follow-up required to determine the incidence and prevalence of EPS.
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Affiliation(s)
- Dorothea Nitsch
- London School of Hygiene & Tropical Medicine, London, United Kingdom UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, United Kingdom
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, United Kingdom
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19
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Tawada M, Ito Y, Hamada C, Honda K, Mizuno M, Suzuki Y, Sakata F, Terabayashi T, Matsukawa Y, Maruyama S, Imai E, Matsuo S, Takei Y. Vascular Endothelial Cell Injury Is an Important Factor in the Development of Encapsulating Peritoneal Sclerosis in Long-Term Peritoneal Dialysis Patients. PLoS One 2016; 11:e0154644. [PMID: 27119341 PMCID: PMC4847858 DOI: 10.1371/journal.pone.0154644] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/15/2016] [Indexed: 12/22/2022] Open
Abstract
Background and Objectives Encapsulating peritoneal sclerosis (EPS) is a rare but serious and life-threatening complication of peritoneal dialysis (PD). However, the precise pathogenesis remains unclear; in addition, predictors and early diagnostic biomarkers for EPS have not yet to be established. Methods Eighty-three peritoneal membrane samples taken at catheter removal were examined to identify pathological characteristics of chronic peritoneal deterioration, which promotes EPS in patients undergoing long-term PD treatment with low occurrence of peritonitis. Results According to univariable logistic regression analysis of the pathological findings, thickness of the peritoneal membrane (P = 0.045), new membrane formation score (P = 0.006), ratio of luminal diameter to vessel diameter (L/V ratio, P<0.001), presence of CD31-negative vessels (P = 0.021), fibrin deposition (P<0.001), and collagen volume fraction (P = 0.018) were associated with EPS development. In analyses of samples with and without EPS matched for PD treatment period, non-diabetes, and PD solution, univariable analysis identified L/V ratio (per 0.1 increase: odds ratio (OR) 0.44, P = 0.003) and fibrin deposition (OR 6.35, P = 0.027) as the factors associated with EPS. L/V ratio was lower in patients with fibrin exudation than in patients without fibrin exudation. Conclusions These findings suggest that damage to vascular endothelial cells, as represented by low L/V ratio, could be a predictive finding for the development of EPS, particularly in long-term PD patients unaffected by peritonitis.
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Affiliation(s)
- Mitsuhiro Tawada
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Ito
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
- * E-mail:
| | - Chieko Hamada
- Department of Nephrology, Juntendo University, Tokyo, Japan
| | - Kazuho Honda
- Department of Pathology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Masashi Mizuno
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Suzuki
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumiko Sakata
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Terabayashi
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihisa Matsukawa
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoichi Maruyama
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Enyu Imai
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Seiichi Matsuo
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshifumi Takei
- Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan
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20
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Onishi A, Akimoto T, Urabe M, Hirahara I, Muto S, Ozawa K, Nagata D, Kusano E. Attenuation of methylglyoxal-induced peritoneal fibrosis: immunomodulation by interleukin-10. J Transl Med 2015; 95:1353-62. [PMID: 26367488 DOI: 10.1038/labinvest.2015.110] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/28/2015] [Accepted: 05/19/2015] [Indexed: 01/07/2023] Open
Abstract
Peritoneal fibrosis (PF), a serious pathophysiology of peritoneal dialysis (PD), is implicated in various types of chronic inflammation. In the present study, we examined the benefits of interleukin (IL)-10, which exerts anti-inflammatory effects, in an experimental rat model of methylglyoxal (MGO)-induced PF. We injected an adeno-associated virus (AAV) vector encoding rat IL-10 or enhanced green fluorescent protein (GFP) into male Sprague-Dawley rats at 6 weeks of age. Four weeks later, the rats received continuous peritoneal injections of conventional PD fluid (PDF) with MGO for 3 weeks. Then, the peritoneal histology and the expression levels of fibrogenic mediators and proinflammatory cytokines were analyzed. The rats demonstrating persistent IL-10 expression showed significantly reduced fibrous peritoneal thickening compared with those with GFP expression. The infiltration of macrophages, the expression of tumor necrosis factor-α, IL-1β, IL-6, transforming growth factor-β1, Snail, and matrix metalloproteinase 2 genes as well as the proliferation of mesenchymal-like mesothelial cells augmented by MGO were all significantly suppressed by IL-10 expression. IL-10 also abrogated the extent of MGO-induced bowel adhesions mimicking a cocoon-like mass. Our findings provide valuable insight into the potential benefit of immunomodulation with IL-10 as one potentially effective therapeutic strategy for preventing the onset of peritoneal injury resulting in PF.
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Affiliation(s)
- Akira Onishi
- Division of Nephrology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Tetsu Akimoto
- Division of Nephrology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Masashi Urabe
- Division of Genetic Therapeutics, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Ichiro Hirahara
- Division of Nephrology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Shigeaki Muto
- Division of Nephrology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Keiya Ozawa
- Division of Genetic Therapeutics, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Eiji Kusano
- Division of Nephrology, Department of Medicine, Jichi Medical University, Tochigi, Japan
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21
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Peritoneal dialysate effluent and serum CA125 concentrations in stable peritoneal dialysis patients. J Nephrol 2015; 29:427-434. [DOI: 10.1007/s40620-015-0250-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/13/2015] [Indexed: 10/22/2022]
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22
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Merino Bueno C, Del Rio García L, Bande Fernández JJ, García R, Hidalgo Ordoñez C, Rodríguez-Suárez C, Sánchez-Álvarez JE. Encapsulating peritoneal sclerosis: A review of 3 cases. Nefrologia 2015; 35:588-90. [PMID: 26560397 DOI: 10.1016/j.nefro.2015.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/15/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Carmen Merino Bueno
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
| | - Laura Del Rio García
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | | | - Raúl García
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Carlos Hidalgo Ordoñez
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Carmen Rodríguez-Suárez
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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Candido PDCM, Werner ADF, Pereira IMF, Matos BA, Pfeilsticker RM, Silva R. Sclerosing encapsulating peritonitis: a case report. Radiol Bras 2015; 48:56-8. [PMID: 25798009 PMCID: PMC4366030 DOI: 10.1590/0100-3984.2013.1909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 01/22/2014] [Indexed: 11/25/2022] Open
Abstract
Sclerosing encapsulating peritonitis, a rare cause of bowel obstruction, was
described as a complication associated with peritoneal dialysis which is much feared
because of its severity. The authors report a case where radiological findings in
association with clinical symptoms have allowed for a noninvasive diagnosis of
sclerosing encapsulating peritonitis, emphasizing the high sensitivity and
specificity of computed tomography to demonstrate the characteristic findings of such
a condition.
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Affiliation(s)
| | | | - Izabela Machado Flores Pereira
- Trainees in Radiology at Hospital Felício Rocho, Fellow degrees at Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Breno Assunção Matos
- Trainees in Radiology at Hospital Felício Rocho, Fellow degrees at Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Raul Silva
- MDs, Radiologists at Hospital Felício Rocho, Belo Horizonte, MG, Brazil
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24
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Davenport A. Late presentation of encapsulating peritoneal sclerosis following renal transplantation and the potential under-reporting of the incidence and prevalence of encapsulating peritoneal sclerosis. Nephrology (Carlton) 2015; 20:499-501. [DOI: 10.1111/nep.12477] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital; University College London Medical School; London UK
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25
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Yamahatsu A, Hamada C, Kaneko K, Io H, Nakata J, Tomino Y. Long-term outcome of encapsulating peritoneal sclerosis (EPS) patients in a single center. Clin Exp Nephrol 2015; 19:961-7. [DOI: 10.1007/s10157-015-1081-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/08/2015] [Indexed: 02/07/2023]
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Hurst H, Summers A, Beaver K, Caress AL. Living with encapsulating peritoneal sclerosis (EPS): the patient's perspective. Perit Dial Int 2014; 34:758-65. [PMID: 24497592 PMCID: PMC4269501 DOI: 10.3747/pdi.2013.00053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 08/18/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although relatively rare, encapsulating peritoneal sclerosis (EPS) is nonetheless a major concern within the renal community. Risk of developing EPS is associated with long-term peritoneal dialysis (PD). High mortality was previously reported, although surgery has since improved outcomes. Research into EPS focuses on imaging and early detection methods, genetics, biomarkers and preventive strategies. No previous studies have examined patients' experiences of EPS. AIMS The aim of the present study was to explore the experience of patients who have undergone surgery for EPS in one center in the North of England. METHODS A qualitative phenomenological approach, involving in-depth interviews, was adopted. Nine participants were recruited out of a total of 18 eligible. Most participants were interviewed twice over a 12-month period (October 2009 to October 2010). ANALYSIS Interpretive data analysis was conducted, following the philosophical tradition of hermeneutics, to draw out themes from the data. Data collection and analysis took place concurrently and participants were sent a summary of their first interview to allow a period of reflection prior to the subsequent interview. RESULTS EPS presented the most serious challenge participants had faced since developing chronic kidney disease (CKD). Three major themes were identified, each with subcategories. The key issues for patients were related to identification of early symptoms and lack of understanding. The patients' sense of 'not being heard' by health care professionals led to a loss of trust and enhanced their feelings of uncertainty. The enormity of the surgery, the suffering, and what they had to endure had an enormous impact, but an overriding aspect of this experience was also the loss they felt for their independence and for the PD therapy over which they had control. CONCLUSIONS The findings of this study highlight a number of important issues relevant to clinical practice, including lack of information and understanding of EPS, particularly its early symptoms At the time patients transfer from peritoneal to hemodialysis, the provision of adequate information about the risks and potential early signs of EPS may not only improve their experiences, but may also assist in early detection.
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Affiliation(s)
- Helen Hurst
- Manchester University, Manchester, UK; Department of Renal Medicine Manchester Royal Infirmary (CMFT), Manchester, UK; University of Central Lancashire, Preston, UK; and University Hospital of South Manchester NHSFT, Manchester, UK
| | - Angela Summers
- Manchester University, Manchester, UK; Department of Renal Medicine Manchester Royal Infirmary (CMFT), Manchester, UK; University of Central Lancashire, Preston, UK; and University Hospital of South Manchester NHSFT, Manchester, UK
| | - Kinta Beaver
- Manchester University, Manchester, UK; Department of Renal Medicine Manchester Royal Infirmary (CMFT), Manchester, UK; University of Central Lancashire, Preston, UK; and University Hospital of South Manchester NHSFT, Manchester, UK
| | - Ann-Louise Caress
- Manchester University, Manchester, UK; Department of Renal Medicine Manchester Royal Infirmary (CMFT), Manchester, UK; University of Central Lancashire, Preston, UK; and University Hospital of South Manchester NHSFT, Manchester, UK
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27
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Stefanidis CJ, Shroff R. Encapsulating peritoneal sclerosis in children. Pediatr Nephrol 2014; 29:2093-103. [PMID: 24258273 DOI: 10.1007/s00467-013-2672-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 10/15/2013] [Accepted: 10/18/2013] [Indexed: 02/01/2023]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare but extremely serious complication of peritoneal dialysis (PD). While EPS has been well recognized in adults on long-term PD, and children can spend many years on PD before a transplant becomes available, only a small number of children with EPS have been described. Two European pediatric registries have recently reported on the prevalence, potential risk factors and outcomes of EPS in children. Although the prevalence of EPS is comparable to that published in adult registries, the outcome of pediatric EPS is significantly better and carries a lower mortality. All studies have shown a greater risk of EPS with a longer dialysis vintage, but it is not known why some individuals are susceptible to EPS development. In this review we discuss current views on the epidemiology, pathogenesis and management strategies for EPS. The hope of the authors is that this review will alert pediatric nephrologists to this rare but extremely serious complication of chronic PD. In the future, collaborative research and the establishment of a pediatric EPS registry may be of importance in helping pediatric nephrologists to recognize the early warning signs of EPS development and thereby to develop strategies for its prevention and optimal management.
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Affiliation(s)
- Constantinos J Stefanidis
- Department of Nephrology, "P. & A. Kyriakou" Children's Hospital of Athens, Thivon and Levadias Str, Goudi, 14562, Athens, Greece,
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Onishi A, Akimoto T, Morishita Y, Hirahara I, Inoue M, Kusano E, Nagata D. Peritoneal fibrosis induced by intraperitoneal methylglyoxal injection: the role of concurrent renal dysfunction. Am J Nephrol 2014; 40:381-90. [PMID: 25358632 DOI: 10.1159/000368424] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/16/2014] [Indexed: 01/29/2023]
Abstract
BACKGROUND Peritoneal fibrosis (PF) is a serious pathophysiology of peritoneal dialysis (PD). An ongoing focus of research is the potential fibrogenic nature of methylglyoxal (MGO) in conventional PD fluid (PDF). The aim of the current study was to explore the effects of the uremic milieu on the promotion of PF by MGO using rats with adenine-induced renal failure (RF). METHODS Adenine-treated Sprague-Dawley rats were randomly assigned to receive continuous peritoneal injections of PDF with or without MGO for three weeks or were left untreated for the same duration. Rats without RF were also assigned to three groups. The peritoneal histology and expression levels of type I collagen, transforming growth factor-β1 (TGF-β1), α-smooth muscle actin (αSMA), Snail, matrix metalloproteinase-2 (MMP-2), advanced glycation end-products (AGEs) and the receptor for AGE (RAGE) were then analyzed. RESULTS Peritoneal treatment with 5 mM MGO accelerated the fibrous peritoneal thickening progression promoted by exposure to standard PDF in the rats with RF, but not in the rats with a normal renal function. Treatment with MGO significantly augmented the proliferation of mesenchymal-like mesothelial cells, accumulation of AGE, de novo expression of αSMA and RAGE and gene expression of type I collagen, TGF-β1, Snail and MMP-2, whereas both MGO and RF alone had, at most, marginal effects on the changes in these biological parameters. CONCLUSIONS In the present study, the adverse effects of MGO on the peritoneum became more prominent under conditions of a uremic milieu. These findings imply that MGO and uremia act cooperatively to induce PF.
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Affiliation(s)
- Akira Onishi
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
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Panorchan K, Davenport A. Diagnostic and prognostic role of peritoneal CA 125 in peritoneal dialysis patients presenting with acute peritonitis. BMC Nephrol 2014; 15:149. [PMID: 25217152 PMCID: PMC4169835 DOI: 10.1186/1471-2369-15-149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 09/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer antigen 125 (CA125) is made by peritoneal mesothelial cells and can be measured in spent dialysate effluent from peritoneal dialysis (PD) patients. It has been suggested that CA125 is a marker of peritoneal mesothelial cell mass and turnover. As PD CA125 increases during peritoneal inflammation, we wished to determine whether measuring PD CA125 during peritonitis provided additional information in determining outcome of peritonitis. METHODS We prospectively measured peritoneal CA125 in 127 adult PD patients presenting with 187 acute episodes of PD peritonitis, measuring peritoneal CA125 from a sample of dialysate effluent obtained from a 4 hour 2 litre 13.6 g/l dextrose peritoneal dwell. RESULTS Mean patient age 60.8 ± 17.1 years, 62.6% male, 33.7% diabetic and the median PD vintage was 22 (11-48) months. 127 patients (66.8%) presented with their first episode of peritonitis, 20% their second episode, 13.2% third or greater. Gram positive bacteria accounted for 64.7% of all peritonitis episodes and Gram negative bacteria 21.1%. Treatment was successful for 151 episodes of PD peritonitis (81.1%). The median PD effluent total WBC was 1240 (430-3660)/ml and serum CRP 67 (20-144) mg/l, with a PD CA125 of 38 (20.3-72.3) IU/l on presentation. There were positive correlations between PD effluent CA125 concentrations and total WBC on presentation (r = 0.41, p = <0.001) and dialysis vintage (r = -0.43, p < 0.001) but not with patient age, diabetic status, or serum CRP.There was no difference in PD effluent CA125 concentrations between Gram positive, and Gram negative peritonitis or between those episodes which responded to treatment, median 38 IU/ml (21-69) vs those with treatment failures 38 IU/ml (15-94). CONCLUSION We did not find any additional diagnostic or prognostic benefit for measuring effluent CA125 in PD patients presenting with acute peritonitis compared to standard investigations, including peritoneal WBC and serum CRP. As such our study would not support the routine measurement of peritoneal CA125 during episodes of peritonitis.
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Affiliation(s)
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, Rowland Hill Street, NW3 2PF London, UK.
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Davenport A. Effect of intra-abdominal dialysate on bioimpedance-derived fluid volume status and body composition measurements in peritoneal dialysis patients. Perit Dial Int 2014; 33:578-9. [PMID: 24133085 DOI: 10.3747/pdi.2012.00069] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Andrew Davenport
- UCL Centre for Nephrology Royal Free Hospital University College London Medical School London, UK
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Goodlad C, Tam FWK, Ahmad S, Bhangal G, North BV, Brown EA. Dialysate cytokine levels do not predict encapsulating peritoneal sclerosis. Perit Dial Int 2014; 34:594-604. [PMID: 24584593 DOI: 10.3747/pdi.2012.00305] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of long-term peritoneal dialysis (PD). There is no well-validated method for predicting which patients will develop the condition, although known risk factors include long duration of PD, high glucose exposure and lack of residual renal function. We have investigated whether dialysate cytokines (MCP-1 (monocyte chemotactic protein-1), CCL18 (pulmonary and activation-regulated cytokine, PARC), IL-6 (interleukin-6), CCL15 (leukotactin) and angiogenin) could be used to predict the onset of EPS more effectively than known clinical risk factors. METHODS Samples of dialysate and clinical data were prospectively collected from 151 patients at the West London Renal center between 2003 and 2010. Dialysate cytokine levels were measured using the enzyme-linked immunoabsorbant assay (ELISA) technique. Encapsulating peritoneal sclerosis subsequently developed in 17 patients during a follow-up period of 27 - 113 months. Cytokines found at higher levels in dialysate of pre-EPS patients were investigated as candidate predictors of EPS using logistic regression analysis. RESULTS Dialysate IL-6, MCP-1 and CCL15 were significantly higher in patients who subsequently developed EPS; however, a logistic regression model using dialysate cytokines to predict EPS was no better than a model using well-recognized clinical markers (length of time on PD and membrane transport status). CONCLUSIONS Although MCP-1, IL-6 and CCL15 were found at higher levels in the dialysate of patients who subsequently developed EPS, dialysate levels of these cytokines do not improve prediction of future EPS above a model using known clinical risk factors.
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Affiliation(s)
- Catriona Goodlad
- Renal Section, Department of Medicine, Imperial College, London, United Kingdom; and Senior Statistician, Queen Mary University of London, London, United Kingdom
| | - Frederick W K Tam
- Renal Section, Department of Medicine, Imperial College, London, United Kingdom; and Senior Statistician, Queen Mary University of London, London, United Kingdom
| | - Sohail Ahmad
- Renal Section, Department of Medicine, Imperial College, London, United Kingdom; and Senior Statistician, Queen Mary University of London, London, United Kingdom
| | - Gurjeet Bhangal
- Renal Section, Department of Medicine, Imperial College, London, United Kingdom; and Senior Statistician, Queen Mary University of London, London, United Kingdom
| | - Bernard V North
- Renal Section, Department of Medicine, Imperial College, London, United Kingdom; and Senior Statistician, Queen Mary University of London, London, United Kingdom
| | - Edwina A Brown
- Renal Section, Department of Medicine, Imperial College, London, United Kingdom; and Senior Statistician, Queen Mary University of London, London, United Kingdom
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Hong KD, Bae JH, Jang YJ, Jung HY, Cho JH, Choi JY, Kim CD, Kim YL, Park SH. Encapsulating peritoneal sclerosis: case series from a university center. Korean J Intern Med 2013; 28:587-93. [PMID: 24009455 PMCID: PMC3759765 DOI: 10.3904/kjim.2013.28.5.587] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 07/18/2012] [Accepted: 07/30/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Encapsulating peritoneal sclerosis (EPS) is an often-fatal complication of long-term peritoneal dialysis (PD). We here report the clinical features of EPS in Korean PD patients from a single university center. METHODS The data were collected retrospectively from 606 PD patients at Kyungpook National University Hospital, between August 2001 and August 2011. The diagnosis of EPS was based on clinical signs and symptoms, and confirmed by radiological findings. RESULTS Eight patients (1.3%, four males) were diagnosed with EPS. The mean age of the patients was 48.5 years (range, 33 to 65). The mean duration of PD was 111.8 months (range, 23 to 186). All patients except for one had three or more episodes of peritonitis. Seven patients were diagnosed with EPS after stopping PD, and only one stayed on PD after initial diagnosis and treatment. Total parenteral nutrition and corticosteroids, in addition to tamoxifen therapy, were used to treat most of the patients, and one patient underwent surgery (adhesiolysis). The overall mortality rate was 50%. CONCLUSIONS EPS is a serious, life-threatening complication in patients on long-term PD. To reduce the incidence and mortality rate of EPS, careful monitoring and early diagnosis is needed.
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Affiliation(s)
- Kyung-Deuk Hong
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea
| | - Ji Hea Bae
- Department of Radiology, Kyungpook National University Hospital, Daegu, Korea
| | - Yun-Jin Jang
- Department of Radiology, Kyungpook National University Hospital, Daegu, Korea
| | - Hee-Yeon Jung
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea
| | - Ji-Young Choi
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea
| | - Sun-Hee Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea
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Vidal E, Edefonti A, Puteo F, Chimenz R, Gianoglio B, Lavoratti G, Leozappa G, Maringhini S, Mencarelli F, Pecoraro C, Ratsch IM, Cannavò R, De Palo T, Testa S, Murer L, Verrina E. Encapsulating peritoneal sclerosis in paediatric peritoneal dialysis patients: the experience of the Italian Registry of Pediatric Chronic Dialysis. Nephrol Dial Transplant 2013; 28:1603-9. [DOI: 10.1093/ndt/gft061] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Enrico Vidal
- Pediatric Nephrology, Dialysis and Transplantation Unit, Department of Pediatrics, University of Padova, Padova, Italy
| | - Alberto Edefonti
- Pediatric Nephrology and Dialysis Unit, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, Milano, Italy
| | - Flora Puteo
- Nephrology Division, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Roberto Chimenz
- Department of Pediatrics, Nephrology Unit, University School of Medicine, Messina, Italy
| | - Bruno Gianoglio
- Nephrology, Dialysis and Transplantation Unit, Regina Margherita Children's Hospital, Torino, Italy
| | | | - Giovanna Leozappa
- Nephrology and Urology Department, Bambino Gesù Children's Hospital, Roma, Italy
| | - Silvio Maringhini
- Pediatric Nephrology Unit, Children's Hospital ‘G. Di Cristina’, A.R.N.A.S. ‘Civico’, Palermo, Italy
| | - Francesca Mencarelli
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - Carmine Pecoraro
- Nephrology and Dialysis Unit, Santobono Children's Hospital, Napoli, Italy
| | | | - Rossella Cannavò
- Dialysis Unit, Nephrology and Dialysis Division, IRCCS Giannina Gaslini, Genova, Italy
| | - Tommaso De Palo
- Nephrology Division, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Sara Testa
- Pediatric Nephrology and Dialysis Unit, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, Milano, Italy
| | - Luisa Murer
- Pediatric Nephrology, Dialysis and Transplantation Unit, Department of Pediatrics, University of Padova, Padova, Italy
| | - Enrico Verrina
- Dialysis Unit, Nephrology and Dialysis Division, IRCCS Giannina Gaslini, Genova, Italy
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Extracellular volume expansion in peritoneal dialysis patients. Int J Artif Organs 2012; 35:338-45. [PMID: 22466994 DOI: 10.5301/ijao.5000080] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2011] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Cardiovascular mortality remains high among peritoneal dialysis (PD) patients. Several small studies have suggested that PD patients are volume expanded, and as such this could be a cardiovascular risk factor. We therefore wished to investigate factors which could lead to extracellular water (ECW) expansion. METHODS Retrospective cross-sectional audit of 600 prevalent, adult PD patients attending two tertiary university PD centers, with corresponding assessments of PD adequacy, transport status, and multifrequency bioimpedance measurements of extracellular water to total body water (ECW/TBW). RESULTS 600 PD patients, median age 57.5 (46.9-67.9) years, 54% male, 31% diabetic, 47.6% Caucasoid, median PD vintage 16 (3.7-38) months, (64% prescribed icodextrin, 34% hypertonic glucose dialysates, and 74% antihypertensive medications). Mean ECW 15.1±0.2 L, ICW 20±0.2 L, ECW/TBW ratio 0.437±0.007. On multivariate analysis %ECW/TBW was associated with age (F=13.1 ß=0.045 p=0.000), number of antihypertensive medications (F=10.3 ß=0.43 p=0.001), log CRP (F=12.9 ß=1.3 p=0.000), and negatively with serum albumin (F=25 ß=-0.22 p=0.000), and residual renal function (urine volume mL F=9.96 ß=-0.001 p=0.002) (weekly Kt/Vurine F=8.82 ß=-2.05, p=0.003). CONCLUSIONS Overhydration as assessed by ECW/TBW is prevalent in adult PD patients, and is associated with loss of residual renal function, inflammation, malnutrition and hypertension - as assessed by antihypertensive medications. As this was a retrospective cross-sectional audit, whether loss of residual renal function, inflammation, and protein energy wasting lead to volume expansion remains to be determined in prospective longitudinal studies.
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Margetts PJ, Hoff C, Liu L, Korstanje R, Walkin L, Summers A, Herrick S, Brenchley P. Transforming growth factor β-induced peritoneal fibrosis is mouse strain dependent. Nephrol Dial Transplant 2012; 28:2015-27. [PMID: 22785109 DOI: 10.1093/ndt/gfs289] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of peritoneal dialysis. The etiology is unclear, but genetic predisposition may be a contributing factor. We used adenovirus-mediated gene transfer of transforming growth factor (TGF) β1 to the peritoneum in four genetically distinct laboratory mouse strains to assess differences in fibrogenic response. METHODS Mice from four genetic backgrounds (C57BL/6J, DBA/2J, C3H/HeJ and SJL/J) received an intraperitoneal injection of an adenovirus expressing TGFβ1 (AdTGFβ1) or control adenovirus (AdDL) and were assessed 4 and 10 days after infection. Submesothelial thickening, angiogenesis and gene expression were quantified from peritoneal tissue. Protein was extracted from omental tissue and assessed for collagen, E-cadherin and TGFβ signaling pathway proteins. RESULTS There was a graded response among the mouse strains to the peritoneal overexpression of TGFβ1. TGFβ1 induced a significant fibrogenic response in the C57BL/6J mice, whereas the SJL/J mice were resistant. The DBA/2J and the C3H/HeJ mice had intermediate responses. A similar graded response was seen in collagen protein levels in the omental tissue and in fibrosis-associated gene expression. TGFβ type 1 receptor and SMAD signaling pathways appeared to be intact in all the mouse strains. CONCLUSIONS There were significant differences in mouse strain susceptibility to peritoneal fibrosis, suggesting that genetic factors may play a role in the development of peritoneal fibrosis and possibly EPS. As early TGFβ1 signaling mechanisms appear to be intact, we hypothesize that fibrosis resistance in the SJL/J mice lies further down the wound-healing cascade or in an alternate, non-SMAD pathway.
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Affiliation(s)
- Peter J Margetts
- Department of Nephrology, McMaster University, Hamilton, Ontario, Canada
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Abstract
Changes to peritoneal membrane function over time result in the development of ultrafiltration failure in a proportion of PD patients and pose a risk for the rarer condition of encapsulating peritoneal sclerosis. These changes are characterized by an increase in the transport rate for small solutes owing to increased vascularity and/or peritoneal blood flow and in more severe cases a reduction in the osmotic conductance of the membrane that likely reflects progressive fibrosis. Both of these processes are preceded by exposure of the membrane to glucose when using conventional dialysis solutions, although this usually is necessitated and likely exacerbated by loss of residual renal function and recurrent peritonitis. Mediators of membrane injury and thus potential biomarkers include inflammatory cytokines, notably local interleukin-6 production, which also appears to determine solute transport characteristics at the start of peritoneal dialysis, local production of vascular endothelial growth factor, and transforming growth factor β-associated epithelial to mesenchymal transition of the mesothelium leading to membrane fibrosis. Low glucose degradation product solutions may ameliorate the mesothelial injury associated with high glucose exposure, but evidence that they prevent or delay changes in membrane function over time is lacking. In the meantime, avoidance of excessive glucose exposure, preservation of residual renal function, and prevention of peritonitis remain the most logical treatment strategies for this problem.
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Affiliation(s)
- Simon J Davies
- Department of Nephrology, University Hospital of North Staffordshire, Stoke on Trent, Staffordshire, UK.
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Korte MR, Sampimon DE, Betjes MGH, Krediet RT. Encapsulating peritoneal sclerosis: the state of affairs. Nat Rev Nephrol 2011; 7:528-38. [PMID: 21808281 DOI: 10.1038/nrneph.2011.93] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a severe complication of long-term peritoneal dialysis (PD) with a 50% mortality rate. EPS is characterized by progressive and excessive fibrotic thickening of the peritoneum, leading to encapsulation of the bowels and intestinal obstruction. At present, EPS cannot be detected with certainty during its early stages; however, a progressive loss of ultrafiltration capacity often precedes its development. Studies that attempted to elucidate the pathogenesis of EPS have shown that the duration of exposure to PD fluids is the most important risk factor for EPS, and that young age and possibly the effects of peritonitis are additional contributory factors. The pathophysiology of EPS is probably best described as a multiple-hit process with a central role for transforming growth factor β. A form of EPS that develops shortly after kidney transplantation has also been recognized as a distinct clinical entity, and may be a common form of EPS in countries with a high transplantation rate. Criteria have been developed to identify EPS by abdominal CT scan at the symptomatic stage, but further clinical research is needed to identify early EPS in asymptomatic patients, to clarify additional risk factors for EPS and to define optimal treatment strategies.
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Affiliation(s)
- Mario R Korte
- Albert Schweitzer Hospital, Department of Internal Medicine, PO Box 444, 3300 AK Dordrecht, The Netherlands.
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Braun N, Alscher MD, Kimmel M, Amann K, Büttner M. Encapsulating peritoneal sclerosis – an overview. Nephrol Ther 2011; 7:162-71. [DOI: 10.1016/j.nephro.2010.12.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 12/28/2010] [Indexed: 12/21/2022]
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Korte MR, Sampimon DE, Lingsma HF, Fieren MW, Looman CW, Zietse R, Weimar W, Betjes MG, Boer W, van den Dorpel M, van Ittersum RF, Konings C, Krediet R, de Sevaux R, Zanen A. Risk Factors Associated with Encapsulating Peritoneal Sclerosis in Dutch Eps Study. Perit Dial Int 2011; 31:269-78. [DOI: 10.3747/pdi.2010.00167] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Encapsulating peritoneal sclerosis (EPS) is a serious complication of peritoneal dialysis (PD) with a multifactorial pathophysiology and possible increasing incidence. The aim of the present study was to evaluate the independent associations of PD duration, age, dialysis fluids, and kidney transplantation with EPS. Methods A multicenter case–control study was performed in the Netherlands from 1 January 1996 until 1 July 2007. The population comprised 63 patients with EPS and 126 control patients. Control patients were selected from the national registry and were matched for date of PD start. Associations were analyzed using a log linear regression model. Primary outcome was appearance of EPS. Results Compared with control patients, patients with EPS were younger at the start of PD (34.7 ± 15.4 years vs. 51.5 ± 14.7 years, p < 0.0001). The cumulative period on PD was longer in EPS patients than in control patients (78.7 ± 37.8 months vs. 32.8 ± 24 months, p < 0.0001), and the cumulative period on icodextrin was also longer in EPS patients (32.7 ± 23.3 months vs. 18.1 ± 15.7 months, p = 0.006). Compared with control patients, more EPS patients underwent kidney transplantation (47 vs. 59, p < 0.0001). With regard to the period after transplantation, the yearly probability of EPS increased in the year after transplantation to 7.5% from 1.75%. In multivariate regression analysis, cumulative PD duration, age at PD start, transplantation, time from last transplantation to EPS, calendar time, time on icodextrin, and ultrafiltration failure were independently associated with EPS. Transfer from PD to hemodialysis for reasons other than suspected EPS could not be identified as a risk factor for EPS. Conclusions Duration of PD, age at PD start, kidney transplantation, time since last transplantation, ultrafiltration failure, and time on icodextrin were associated with a higher risk of EPS.
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Affiliation(s)
- Mario R. Korte
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht
- Department of Nephrology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Denise E. Sampimon
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam
| | | | - Marien W. Fieren
- Department of Nephrology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Robert Zietse
- Department of Nephrology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Willem Weimar
- Department of Nephrology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | | | | | | | | | | | | | - A.L. Zanen
- Deventer Hospital, Deventer, Netherlands
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Wilkie M. Exploring the Association between Icodextrin and Encapsulating Peritoneal Sclerosis. Perit Dial Int 2011; 31:259-62. [DOI: 10.3747/pdi.2011.00062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Martin Wilkie
- Sheffield Teaching Hospitals NHS University of Sheffield Sheffield, UK
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Davenport A, Sayed RH, Fan S. Is Extracellular Volume Expansion of Peritoneal Dialysis Patients Associated with Greater Urine Output? Blood Purif 2011; 32:226-31. [DOI: 10.1159/000329732] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 05/22/2011] [Indexed: 11/19/2022]
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