Related Experiment Videos
Long-term peritoneal dialysis is a risk factor of sclerosing encapsulating peritonitis for children
1Department of Nephrology, Tokyo Metropolitan Kiyose Children's Hospital, Japan. y.araki@ma2.justnet.ne.jp
Insights
Long-term peritoneal dialysis (PD) increases the risk of sclerosing encapsulating peritonitis (SEP). If patients on PD for over 5 years show peritoneal calcification and poor ultrafiltration, a biopsy is recommended to detect peritoneal sclerosis (PS) and discontinue PD if necessary.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Gastroenterology
Background:
- Sclerosing encapsulating peritonitis (SEP) is a severe complication of peritoneal dialysis (PD) with high mortality.
- Peritoneal sclerosis (PS) is a histological finding often associated with SEP.
- Preventing SEP is crucial for pediatric patients requiring long-term PD.
Purpose of the Study:
- To investigate the characteristics of patients with PS.
- To determine optimal timing for peritoneal biopsies in long-term PD patients.
- To establish safe duration limits for PD.
Main Methods:
- Retrospective single-center study.
- Analysis of 16 pediatric patients on PD for over 5 years.
- Peritoneal biopsies performed on 14 patients, categorized into PS and peritoneal fibrosis (PF) groups.
Main Results:
- The risk of PS increased with PD duration: 57% after 5 years, 80% after 8 years, and 100% after 10 years.
- SEP occurred in 2 patients within the PS group.
- Peritoneal calcification on CT scans and poor ultrafiltration were consistent findings in PS patients.
Conclusions:
- Long-term PD is a significant risk factor for SEP.
- Peritoneal biopsy is recommended for PD patients >5 years with calcification and poor ultrafiltration.
- Discontinuation of PD is advised upon PS diagnosis to prevent SEP.
Objective:
Sclerosing encapsulating peritonitis (SEP) is a clinical syndrome with a high mortality rate and is a serious complication of peritoneal dialysis (PD). Peritoneal sclerosis (PS) is a histological diagnosis. PS is usually observed in the peritoneal specimens of patients with SEP. Avoiding SEP is considered to be extremely important for pediatric patients who may require long-term PD. In this study, the characteristics of patients with PS were investigated to determine when to perform peritoneal biopsies and how long PD can be performed safely.
Design:
A retrospective single-center study.
Setting:
Tokyo Metropolitan Kiyose Children's Hospital.
Patients:
A total of 109 children younger than 16 years have received chronic PD in our unit since 1981. Among these children, 16 patients had been on PD for more than 5 years (mean 7.4+/-2.5 years) from May 1992 to March 1999. Peritoneal biopsies were performed in 14 of the 16 patients, who were divided into two groups based on the histological diagnoses: a PS and a peritoneal fibrosis (PF) group.
Results:
The 14 patients were on PD for a mean of 7.8+/-2.5 years. There were 8 patients with PS and 6 patients with PF. SEP was observed in 2 patients in the PS group. The risk of PS increased with the duration of PD: 57% (8/14) > 5 years, 80% (4/5) > 8 years, and 100% (3/3) > 10 years. All patients in the PS group showed both peritoneal calcifications on abdominal CT scan and poor ultrafiltration at the time of diagnoses.
Conclusion:
Long-term PD was the important risk factor of SEP. If both peritoneal calcification on abdominal CT scan and poor ultrafiltration are observed in a patient on PD more than 5 years, a peritoneal biopsy should be performed. If PS is detected, PD should be discontinued.