Encapsulating Peritoneal Sclerosis: A Single-Center Experience
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Background: Encapsulating peritoneal sclerosis (EPS) is a serious and often fatal complication of long-term peritoneal dialysis (PD) with severe malnutrition and poor prognosis. We aimed to investigate the incidence and clinical features of EPS in patients on PD. Methods: The data were collected retrospectively from 603 prevalent PD patients in the Kyungpook National University Hospital between August 2001 and July 2011. EPS was diagnosed by the 2000 criteria of the International Society of Peritoneal Dialysis. Results: Eight patients (1.3%) met the diagnostic criteria of EPS. They had at least one of three symptoms: abdominal pain, vomiting and abdominal distension. Mean age of patients was 48.5 (range: 33 to 65) years and 4 were men. Mean duration on PD was 111.7 (range: 23 to 186) months. Seven patients had chronic glomerulonephritis as underlying renal disease, and one patient hypertensive nephrosclerosis. All patients except one had 2 or more episodes of peritonitis, the peritonitis rate being 1/33.7 patient-months in the 8 EPS patients. Six patients were treated with icodextrin solution. Four patients were treated with beta-blocker (cavedilol, 25-50 mg daily). Total parenteral nutrition was used in all patients. Only one patient had elective surgical intervention, adhesiolysis. Four patients were treated with glucocorticoid (0.5~1 mg/kg/day), three with tamoxifen (10-20 mg daily) and three with both. Of the 8 patients diagnosed with EPS, 6 survived and 2 died, an overall mortality rate being 25%. Conclusion: EPS is rare but a serious life threatening complication in patients on long-term PD. To reduce the incidence and mortality of EPS, careful monitoring and intensive therapy may be needed. Keywords: Encapsulating peritoneal sclerosis, Peritonitis, Continuous ambulatory peritoneal dialysis.
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