1
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Maeda T, Io H, Hara K, Nakata J, Ishizaka M, Shimizu Y, Shirotani Y, Fukuzaki H, Suzuki Y. Laparoscopic observations of adhesions between peritoneal dialysis catheters and intraperitoneal organs: A retrospective, observational study. Nephrology (Carlton) 2023; 28:684-687. [PMID: 37602968 DOI: 10.1111/nep.14230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/25/2023] [Accepted: 08/04/2023] [Indexed: 08/22/2023]
Abstract
Laparoscopy provides extensive data for the decannulation of a peritoneal dialysis catheter and is being increasingly used to diagnose encapsulating peritoneal sclerosis. However, there are few reports on the methods of decannulation of peritoneal dialysis catheters. In this study, we examined the laparoscopic findings and postoperative complications of patients undergoing peritoneal dialysis catheter removal. A total of 119 laparoscopic decannulations of peritoneal dialysis catheters were performed between 2003 and 2018 at the Juntendo University Hospital and Juntendo University Nerima Hospital. Laparoscopy was performed during peritoneal dialysis catheter removal by a gastrointestinal surgeon. Patient characteristics such as age, sex, duration of peritoneal dialysis, history of peritonitis and age at the time of peritoneal dialysis termination were assessed. Of these 119 cases, 19 (16.0%) showed adhesion between the peritoneal dialysis catheter and intraperitoneal organs. There were 13 (10.9%) cases involving a tangled omentum, 4 (3.4%) cases involving the small intestine and 2 (1.7%) cases of adhesions extending from the bowels to the abdominal wall. No postoperative complications were associated with the laparoscopic surgery. In these cases, blind decannulation of the peritoneal dialysis catheter may result in injury to the gastrointestinal tract in patients with adhesions. Therefore, we need to pay attention to adhesions between peritoneal dialysis catheters and intraperitoneal organs, and laparoscopy could be a valuable tool in detecting such adhesions and ensuring patient safety.
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Affiliation(s)
- Takuya Maeda
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hiroaki Io
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kazuaki Hara
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Junichiro Nakata
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masanori Ishizaka
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Yuki Shimizu
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuka Shirotani
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Haruna Fukuzaki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
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2
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Kadoya H, Hirano A, Umeno R, Kajimoto E, Iwakura T, Kondo M, Wada Y, Kidokoro K, Kishi S, Nagasu H, Sasaki T, Taniguchi S, Takahashi M, Kashihara N. Activation of the inflammasome drives peritoneal deterioration in a mouse model of peritoneal fibrosis. FASEB J 2023; 37:e23129. [PMID: 37606578 DOI: 10.1096/fj.202201777rrr] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 07/10/2023] [Accepted: 07/25/2023] [Indexed: 08/23/2023]
Abstract
During peritoneal dialysis (PD), the peritoneum is exposed to a bioincompatible dialysate, deteriorating the tissue and limiting the long-term effectiveness of PD. Peritoneal fibrosis is triggered by chronic inflammation induced by a variety of stimuli, including peritonitis. Exposure to PD fluid alters peritoneal macrophages phenotype. Inflammasome activation triggers chronic inflammation. First, it was determined whether inflammasome activation causes peritoneal deterioration. In the in vivo experiments, the increased expression of the inflammasome components, caspase-1 activity, and concomitant overproduction of IL-1β and IL-18 were observed in a mouse model of peritoneal fibrosis. ASC-positive and F4/80-positive cells colocalized in the subperitoneal mesothelial cell layer. These macrophages expressed high CD44 levels indicating that the CD44-positive macrophages contribute to developing peritoneal deterioration. Furthermore, intravital imaging of the peritoneal microvasculature demonstrated that the circulating CD44-positive leukocytes may contribute to peritoneal fibrosis. Bone marrow transplantation in ASC-deficient mice suppressed inflammasome activation, thereby attenuating peritoneal fibrosis in a high glucose-based PD solution-injected mouse model. Our results suggest inflammasome activation in CD44-positive macrophages may be involved in developing peritoneal fibrosis. The inflammasome-derived pro-inflammatory cytokines might therefore serve as new biomarkers for developing encapsulating peritoneal sclerosis.
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Affiliation(s)
- Hiroyuki Kadoya
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Akira Hirano
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Reina Umeno
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Eriko Kajimoto
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Tsukasa Iwakura
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Megumi Kondo
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshihisa Wada
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Kengo Kidokoro
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Seiji Kishi
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Hajime Nagasu
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Tamaki Sasaki
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Shun'ichiro Taniguchi
- Advanced Cancer Medicine for Gynecologic Cancer, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Masafumi Takahashi
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
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Leventoğlu E, Büyükkaragöz B, Dalgıç A, Fidan K, Söylemezoğlu O, Bakkaloğlu SA. Encapsulated Peritoneal Sclerosis in an Adolescent With Kidney Transplant After Long-Term Peritoneal Dialysis. EXP CLIN TRANSPLANT 2022; 20:112-114. [PMID: 35570613 DOI: 10.6002/ect.pediatricsymp2022.o35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Encapsulated peritoneal sclerosis is a rare complication of long-term peritoneal dialysis that has a high rate of morbidity and mortality. We present an 18-year-old female patient who was first diagnosed with renal failure at 8 years of age and who had 7 years of peritoneal dialysis and then hemodialysis before kidney transplant from a deceased donor. Before transplant, the patient developed encapsulated peritoneal sclerosis and was treated with tamoxifen and steroids. Three years after transplant, the patient presented with complaints of vomiting, abdominal pain, and abdominal distension and was again diagnosed with encapsulated peritoneal sclerosis. The patient required excretory paracentesis, pulse steroid treatment for 3 days, and treatment with methylprednisone and tamoxifen, which resulted in regression of signs and symptoms. Factors such as long-term peritoneal dialysis, a history of bacterial peritonitis, and use of high-concentration dialysate may cause encapsulated peritoneal sclerosis, but symptoms can recur after transplant, as shown in our patient. Thus, it is important to recognize that encapsulated peritoneal sclerosis may cause graft loss due to the various complications that it can cause.
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Affiliation(s)
- Emre Leventoğlu
- From the Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
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Hamada C, Tomino Y. Recent Understanding of Peritoneal Pathology in Peritoneal Dialysis Patients in Japan. Blood Purif 2021; 50:719-728. [PMID: 33567422 DOI: 10.1159/000510282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/09/2020] [Indexed: 11/19/2022]
Abstract
The thin peritoneum covering the peritoneal cavity has been used as a dialysis membrane for peritoneal dialysis (PD) because it is highly vascularized and has a large body surface area. However, it has been reported that peritoneal membranes affected by peritonitis, as well as those exposed to the nonphysiological high glucose levels containing PD dialysate, may undergo histological and functional changes. Patients undergoing PD may experience encapsulating peritoneal sclerosis (EPS), which is a life-threatening serious complication of PD that can significantly impair activities of daily living. The incidence of EPS was 1.4-7.3% of maintenance PD patients in the 1980s. The incidence has improved to 1.0% after a neutral dialysate became the standard PD treatment in Japan. Furthermore, the pathogenesis of EPS is uncertain although its onset may be explained by the "two-hit theory," in which some factors leading to impairment had an additive effect on simple peritoneal sclerosis. The evaluation of histopathological findings has shown the impact of the neutral dialysate on peritoneal deterioration as well as its role in the development of functional changes. In the present report, we discuss the advances in the understanding of peritoneal deterioration based on histological and macroscopic evaluations of the peritoneum of patients undergoing PD. We also discuss the recent treatment for PD patients.
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Affiliation(s)
- Chieko Hamada
- Advanced Research Institute for Health Science, Faculty of Medicine, Juntendo University, Tokyo, Japan,
| | - Yasuhiko Tomino
- Asian Pacific Renal Research Promotion Office, Medical Corporation SHOWAKAI, Tokyo, Japan
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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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Edmundson P, Adkins C, Smith B. Cocoon abdomen after chronic peritoneal dialysis. Proc (Bayl Univ Med Cent) 2019; 32:227-228. [PMID: 31191134 DOI: 10.1080/08998280.2018.1551683] [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: 04/19/2017] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022] Open
Abstract
A 66-year-old man presented with nausea, vomiting, and ascites. At laparotomy, an extensive fibrosis of the peritoneum was found to encase the bowel in a cocoon-like fashion. A meticulous dissection was undertaken to strip this encapsulating membrane from the bowel. Histologic study of the excised tissue disclosed extensive hyalinized fibroconnective tissue.
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Affiliation(s)
- Philip Edmundson
- Department of Surgery, Baylor University Medical CenterDallasTexas
| | - Claire Adkins
- Department of Surgery, Baylor University Medical CenterDallasTexas
| | - Bruce Smith
- Department of Surgery, Baylor University Medical CenterDallasTexas
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7
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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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8
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Moinuddin Z, Summers A, Van Dellen D, Augustine T, Herrick SE. Encapsulating peritoneal sclerosis-a rare but devastating peritoneal disease. Front Physiol 2015; 5:470. [PMID: 25601836 PMCID: PMC4283512 DOI: 10.3389/fphys.2014.00470] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/16/2014] [Indexed: 01/08/2023] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a devastating but, fortunately, rare complication of long-term peritoneal dialysis. The disease is associated with extensive thickening and fibrosis of the peritoneum resulting in the formation of a fibrous cocoon encapsulating the bowel leading to intestinal obstruction. The incidence of EPS ranges between 0.7 and 3.3% and increases with duration of peritoneal dialysis therapy. Dialysis fluid is hyperosmotic, hyperglycemic, and acidic causing chronic injury and inflammation in the peritoneum with loss of mesothelium and extensive tissue fibrosis. The pathogenesis of EPS, however, still remains uncertain, although a widely accepted hypothesis is the "two-hit theory," where, the first hit is chronic peritoneal membrane injury from long standing peritoneal dialysis followed by a second hit such as an episode of peritonitis, genetic predisposition and/or acute cessation of peritoneal dialysis, leading to EPS. Recently, EPS has been reported in patients shortly after transplantation suggesting that this procedure may also act as a possible second insult. The process of epithelial-mesenchymal transition of mesothelial cells is proposed to play a central role in the development of peritoneal sclerosis, a common characteristic of patients on dialysis, however, its importance in EPS is less clear. There is no established treatment for EPS although evidence from small case studies suggests that corticosteroids and tamoxifen may be beneficial. Nutritional support is essential and surgical intervention (peritonectomy and enterolysis) is recommended in later stages to relieve bowel obstruction.
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Affiliation(s)
- Zia Moinuddin
- Department of Transplantation, Manchester Royal Infirmary Manchester, UK ; Faculty of Medical and Human Sciences, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre Manchester, UK
| | - Angela Summers
- Department of Transplantation, Manchester Royal Infirmary Manchester, UK
| | - David Van Dellen
- Department of Transplantation, Manchester Royal Infirmary Manchester, UK
| | - Titus Augustine
- Department of Transplantation, Manchester Royal Infirmary Manchester, UK
| | - Sarah E Herrick
- Faculty of Medical and Human Sciences, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre Manchester, UK
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Roriz D, Abreu I, Costa JF, Soares PB, Caseiro-Alves F. An unusual case of extensive peritoneal calcification: A case report. Eur J Radiol Open 2014; 2:7-10. [PMID: 26937431 PMCID: PMC4750637 DOI: 10.1016/j.ejro.2014.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 11/26/2014] [Accepted: 12/02/2014] [Indexed: 11/30/2022] Open
Abstract
The peritoneum is the largest serous membrane of the body and can be exposed to several injuries that may cause abnormal findings on imaging exams. Linear peritoneal calcification is remarkably rare, usually secondary to long duration peritoneal dialysis. We report an uncommon case of extensive peritoneal calcification in a 39-year-old female without long exposure to peritoneal dialysis solutions, in which peritoneal calcification could be linked to Alport syndrome and previous adverse reaction to intraperitoneal iodinated contrast. Radiologist should be aware of this and related imaging findings, know when to search for them as well as understand their clinical value.
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Affiliation(s)
- Diogo Roriz
- Medical Imaging Department and Faculty of Medicine, University Hospital of Coimbra, Praceta Mota Pinto/Av. Bissaya Barreto, 3000-075 Coimbra, Portugal
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10
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Latus J, Habib SM, Kitterer D, Korte MR, Ulmer C, Fritz P, Davies S, Lambie M, Alscher MD, Betjes MGH, Segerer S, Braun N. Histological and clinical findings in patients with post-transplantation and classical encapsulating peritoneal sclerosis: a European multicenter study. PLoS One 2014; 9:e106511. [PMID: 25171219 PMCID: PMC4149574 DOI: 10.1371/journal.pone.0106511] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/30/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Encapsulating peritoneal sclerosis (EPS) commonly presents after peritoneal dialysis has been stopped, either post-transplantation (PT-EPS) or after switching to hemodialysis (classical EPS, cEPS). The aim of the present study was to investigate whether PT-EPS and cEPS differ in morphology and clinical course. METHODS In this European multicenter study we included fifty-six EPS patients, retrospectively paired-matched for peritoneal dialysis (PD) duration. Twenty-eight patients developed EPS after renal transplantation, whereas the other twenty-eight patients were classical EPS patients. Demographic data, PD details, and course of disease were documented. Peritoneal biopsies of all patients were investigated using histological criteria. RESULTS Eighteen patients from the Netherlands and thirty-eight patients from Germany were included. Time on PD was 78(64-95) in the PT-EPS and 72(50-89) months in the cEPS group (p>0.05). There were no significant differences between the morphological findings of cEPS and PT-EPS. Podoplanin positive cells were a prominent feature in both groups, but with a similar distribution of the podoplanin patterns. Time between cessation of PD to the clinical diagnosis of EPS was significantly shorter in the PT-EPS group as compared to cEPS (4(2-9) months versus 23(7-24) months, p<0.001). Peritonitis rate was significantly higher in cEPS. CONCLUSIONS In peritoneal biopsies PT-EPS and cEPS are not distinguishable by histomorphology and immunohistochemistry, which argues against different entities. The critical phase for PT-EPS is during the first year after transplantation and therefore earlier after PD cessation then in cEPS.
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Affiliation(s)
- Joerg Latus
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Sayed M. Habib
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Daniel Kitterer
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Mario R. Korte
- Department of Internal Medicine, Division of Nephrology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Christoph Ulmer
- Department of General, Visceral and Trauma Surgery, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Peter Fritz
- Department of Diagnostic Medicine, Division of Pathology, Robert-Bosch Hospital, Stuttgart, Germany
| | - Simon Davies
- Institute for Science and Technology in Medicine, Keele University, Keele, United Kingdom
| | - Mark Lambie
- Department of Nephrology, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom
| | - M. Dominik Alscher
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Michiel G. H. Betjes
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stephan Segerer
- Division of Nephrology, University Hospital, Zurich, Switzerland
| | - Niko Braun
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
- * E-mail:
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Nakayama M, Terawaki H. Multidisciplinary clinical strategies for encapsulating peritoneal sclerosis in peritoneal dialysis: update from Japan. Int J Urol 2014; 21:755-61. [PMID: 24673567 DOI: 10.1111/iju.12445] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 02/16/2014] [Indexed: 01/01/2023]
Abstract
Peritoneal dialysis is established as a first-line standard renal replacement therapy for end-stage renal disease. However, the development of encapsulating peritoneal sclerosis has been a critical complication among long-term peritoneal dialysis patients. During the past decade, multidisciplinary approaches have been used to suppress encapsulating peritoneal sclerosis. The present article reviews the historical and present status of encapsulating peritoneal sclerosis in Japan.
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Affiliation(s)
- Masaaki Nakayama
- Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine, Fukushima, Japan
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12
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Nakayama M, Miyazaki M, Honda K, Kasai K, Tomo T, Nakamoto H, Kawanishi H. Encapsulating peritoneal sclerosis in the era of a multi-disciplinary approach based on biocompatible solutions: the NEXT-PD study. Perit Dial Int 2014; 34:766-74. [PMID: 24497585 DOI: 10.3747/pdi.2013.00074] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Encapsulating peritoneal sclerosis (EPS) is a serious complication of peritoneal dialysis (PD). Over the past decade in Japan, a multidisciplinary approach has been adopted to minimize the incidence and improve outcomes of EPS. This strategy includes planned PD discontinuation for high-risk patients and the introduction of biocompatible solutions. This study examined the current clinical status of EPS in representative PD centers in Japan. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS Patients (n = 1,338) from 55 PD centers in Japan who were using neutral-pH solutions from the initiation of therapy (mean age, 62 years; median PD duration, 32 months; concomitant use of icodextrin, 35.2%; PD and hemodialysis combination therapy, 12.2%) were assessed every 6 months to ascertain the reasons for PD discontinuation and the development of EPS development. Outcomes were also recorded. The study period was from November 2008 to March 2012. RESULTS There were 727 patients who discontinued PD, including 163 deaths. Among all causes of PD withdrawal except for death, planned PD discontinuation to avoid EPS was utilized in 58 cases (7.1% in total). The strategy was increasingly utilized in proportion to the duration of PD: 0.5% for patients undergoing PD for < 3 years, 0.6% for patients undergoing PD for 5 years, 14.7% for patients undergoing PD for 8 years, and 35.5% for patients undergoing PD for > 8 years. Fourteen patients developed EPS (three cases after PD), which corresponded with an overall incidence of 1.0%. The incidence according to the duration of PD was 0.3% for PD < 3 years, 0.6% for PD = 5 years, 2.3% for PD = 8 years, and 1.2% for PD > 8 years. In terms of therapy, 11 patients were treated with prednisolone (PSL), and surgical enterolysis was utilized in two cases. Complete remission of abdominal symptoms was achieved in twelve patients (85.7%), and three died due to EPS (mortality rate of 21.4%). CONCLUSIONS Use of the multidisciplinary approach described above reduces the risk of the development of EPS according to PD duration. In cases of de novo EPS cases in Japan, this strategy can also attenuate the clinical course of the condition.
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Affiliation(s)
- Masaaki Nakayama
- Tohoku University Graduate School of Medicine, Sendai, Japan; Fukushima Medical University School of Medicine, Fukushima, Japan; Miyazaki Clinic, Nagasaki, Japan; Tokyo Women's Medical University School of Medicine, Tokyo, Japan; Fuji City General Hospital, Fuji, Japan; Oita University School of Medicine, Oita, Japan; Saitama Medical University, Saitama, Japan; and Tsuchiya General Hospital, Hiroshima, Japan Tohoku University Graduate School of Medicine, Sendai, Japan; Fukushima Medical University School of Medicine, Fukushima, Japan; Miyazaki Clinic, Nagasaki, Japan; Tokyo Women's Medical University School of Medicine, Tokyo, Japan; Fuji City General Hospital, Fuji, Japan; Oita University School of Medicine, Oita, Japan; Saitama Medical University, Saitama, Japan; and Tsuchiya General Hospital, Hiroshima, Japan
| | - Masanobu Miyazaki
- Tohoku University Graduate School of Medicine, Sendai, Japan; Fukushima Medical University School of Medicine, Fukushima, Japan; Miyazaki Clinic, Nagasaki, Japan; Tokyo Women's Medical University School of Medicine, Tokyo, Japan; Fuji City General Hospital, Fuji, Japan; Oita University School of Medicine, Oita, Japan; Saitama Medical University, Saitama, Japan; and Tsuchiya General Hospital, Hiroshima, Japan
| | - Kazuho Honda
- Tohoku University Graduate School of Medicine, Sendai, Japan; Fukushima Medical University School of Medicine, Fukushima, Japan; Miyazaki Clinic, Nagasaki, Japan; Tokyo Women's Medical University School of Medicine, Tokyo, Japan; Fuji City General Hospital, Fuji, Japan; Oita University School of Medicine, Oita, Japan; Saitama Medical University, Saitama, Japan; and Tsuchiya General Hospital, Hiroshima, Japan
| | - Kenji Kasai
- Tohoku University Graduate School of Medicine, Sendai, Japan; Fukushima Medical University School of Medicine, Fukushima, Japan; Miyazaki Clinic, Nagasaki, Japan; Tokyo Women's Medical University School of Medicine, Tokyo, Japan; Fuji City General Hospital, Fuji, Japan; Oita University School of Medicine, Oita, Japan; Saitama Medical University, Saitama, Japan; and Tsuchiya General Hospital, Hiroshima, Japan
| | - Tadashi Tomo
- Tohoku University Graduate School of Medicine, Sendai, Japan; Fukushima Medical University School of Medicine, Fukushima, Japan; Miyazaki Clinic, Nagasaki, Japan; Tokyo Women's Medical University School of Medicine, Tokyo, Japan; Fuji City General Hospital, Fuji, Japan; Oita University School of Medicine, Oita, Japan; Saitama Medical University, Saitama, Japan; and Tsuchiya General Hospital, Hiroshima, Japan
| | - Hidetomo Nakamoto
- Tohoku University Graduate School of Medicine, Sendai, Japan; Fukushima Medical University School of Medicine, Fukushima, Japan; Miyazaki Clinic, Nagasaki, Japan; Tokyo Women's Medical University School of Medicine, Tokyo, Japan; Fuji City General Hospital, Fuji, Japan; Oita University School of Medicine, Oita, Japan; Saitama Medical University, Saitama, Japan; and Tsuchiya General Hospital, Hiroshima, Japan
| | - Hideki Kawanishi
- Tohoku University Graduate School of Medicine, Sendai, Japan; Fukushima Medical University School of Medicine, Fukushima, Japan; Miyazaki Clinic, Nagasaki, Japan; Tokyo Women's Medical University School of Medicine, Tokyo, Japan; Fuji City General Hospital, Fuji, Japan; Oita University School of Medicine, Oita, Japan; Saitama Medical University, Saitama, Japan; and Tsuchiya General Hospital, Hiroshima, Japan
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13
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Latus J, Ulmer C, Fritz P, Rettenmaier B, Biegger D, Lang T, Ott G, Scharpf C, Kimmel M, Steurer W, Alscher MD, Braun N. Encapsulating peritoneal sclerosis: a rare, serious but potentially curable complication of peritoneal dialysis–experience of a referral centre in Germany. Nephrol Dial Transplant 2012; 28:1021-30. [DOI: 10.1093/ndt/gfs159] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare complication of peritoneal dialysis (PD), but carries significant morbidity and mortality. We review the clinical features and radiologic and histologic changes found at diagnosis of EPS. Although EPS is strongly associated with the duration of PD, the pathogenesis remains only partly understood. We discuss the mechanisms thought to underlie the abnormally thickened, sclerotic peritoneal membrane seen in long-term PD patients including epithelial to mesenchymal transition and the molecular mediators of fibrosis and angiogenesis. We review how exposure to high-glucose, nonphysiological dialysis fluids, peritonitis, and uremia may be responsible for these changes. Much remains to be learned about optimal management of EPS, both medical and surgical, because the literature lacks controlled studies. Future research challenges include defining the role of surgery, immunosuppression, and antifibrotic agents in the management of EPS. We also need to understand why some patients progress from asymptomatic peritoneal sclerosis to the extreme levels of fibrin deposition and bowel encapsulation seen in EPS. Screening PD patients for potential future EPS remains difficult, and we need strategies for monitoring patients on longer-term PD that enable us to better quantify the risk of EPS for the individual patient.
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Affiliation(s)
- Catriona Goodlad
- Imperial College Kidney and Transplant Institute, Hammersmith Hospital, London, UK.
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15
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Chadha V, Schaefer FS, Warady BA. Dialysis-associated peritonitis in children. Pediatr Nephrol 2010; 25:425-40. [PMID: 19190935 PMCID: PMC2810362 DOI: 10.1007/s00467-008-1113-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 11/18/2008] [Accepted: 12/09/2008] [Indexed: 01/06/2023]
Abstract
Peritonitis remains a frequent complication of peritoneal dialysis in children and is the most common reason for technique failure. The microbiology is characterized by a predominance of Gram-positive organisms, with fungi responsible for less than 5% of episodes. Data collected by the International Pediatric Peritonitis Registry have revealed a worldwide variation in the bacterial etiology of peritonitis, as well as in the rate of culture-negative peritonitis. Risk factors for infection include young age, the absence of prophylactic antibiotics at catheter placement, spiking of dialysis bags, and the presence of a catheter exit-site or tunnel infection. Clinical symptoms at presentation are somewhat organism specific and can be objectively assessed with a Disease Severity Score. Whereas recommendations for empiric antibiotic therapy in children have been published by the International Society of Peritoneal Dialysis, epidemiologic data and antibiotic susceptibility data suggest that it may be desirable to take the patient- and center-specific history of microorganisms and their sensitivity patterns into account when prescribing initial therapy. The vast majority of patients are treated successfully and continue peritoneal dialysis, with the poorest outcome noted in patients with peritonitis secondary to Gram-negative organisms or fungi and in those with a relapsing infection.
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Affiliation(s)
- Vimal Chadha
- Department of Pediatrics, Section of Nephrology, Virginia Commonwealth University Medical Center, Richmond, VA USA
| | - Franz S. Schaefer
- Center for Pediatric and Adolescent Medicine, Section of Pediatric Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Bradley A. Warady
- Department of Pediatrics, Section of Nephrology, The Children’s Mercy Hospital, Kansas City, MO USA
- University of Missouri–Kansas City School of Medicine, The Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108 USA
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