Is encapsulating peritoneal sclerosis a threatening issue in continuous ambulatory peritoneal dialysis? The Japanese experience.

Encapsulating peritoneal sclerosis (EPS) is undoubtedly the most serious complication of continuous ambulatory peritoneal dialysis treatment in Japan, with a mortality rate ranging from about 39% to 49% in reported series. Cases of EPS have been linked to long-term peritoneal dialysis, and limitations on renal transplantation in Japan mean that most Japanese patients have to accept long-term dialysis therapy, which is a critical problem. Treatment alternatives for EPS include total parenteral nutrition, prednisolone administration, and surgical approaches, all of which have varying success rates. Additional therapeutic and new preventive measures have to be established for EPS.

Fifteen cases of encapsulating peritoneal sclerosis related to peritoneal dialysis: a single-center experience in Japan.

To evaluate the incidence and characteristics of encapsulating peritoneal sclerosis (EPS), we analyzed 111 patients who had been transferred to hemodialysis and had been periodically monitored using the peritoneal equilibration test. Encapsulating peritoneal sclerosis was diagnosed in 11 patients. All patients had high-transport peritoneum, and 10 patients had been treated with continuous ambulatory peritoneal dialysis (CAPD) for more than 72 months. Incidence of EPS increased according to prolongation of CAPD. To evaluate outcome, we analyzed 15 cases of EPS. All patients were treated with total parenteral nutrition (TPN). Five patients improved with TPN alone. However, the remaining 10 patients showed deterioration. Of those 10, 4 patients died. They had not been treated with corticosteroids (CSs). The remaining 6 patients were treated with CSs, but they did not improve. Those cases required surgical treatment. The postoperative course in 4 patients was satisfactory, but 2 patients died. In our center, the EPS survival rate was 60%. In patients treated with TPN alone, the remission rate was only 33.3%. Administration of CSs could not improve that rate. In 6 patients treated with surgery, the mortality rate was 33.3%. When EPS symptoms are not ameliorated by CS and TPN, surgical treatment should be considered. To prevent EPS, high-risk patients who have more than 72 months on CAPD and who have a high-transport peritoneum should discontinue CAPD.