Encapsulating peritoneal sclerosis in patients undergoing continuous ambulatory peritoneal dialysis in Japan

Encapsulating peritoneal sclerosis (EPS) is recognized as a serious complication in patients on continuous ambulatory peritoneal dialysis (CAPD). We retrospectively studied the management of CAPD patients who developed EPS in 157 CAPD centers in Japan. Among 11,549 patients undergoing CAPD between 1980 and 2000 in 157 centers, 256 patients developed EPS. The EPS developed between 10 and 168 months (average: 99.6 months) after the start of CAPD. Of the 256 patients who developed EPS, 104 (40.6%) were using high glucose CAPD solution; however, 135 (52.7%) were not. Only 27 patients who developed EPS (10.5%) were using beta-blockers; many other patients were not. A history of peritonitis was seen in 232 patients (90.6%), but not in 11 other patients (4.3%). The average frequency of peritonitis before development of EPS was 3.3 times higher in patients who developed EPS than in those who did not. Various therapeutic approaches were tried with 101 of the patients who developed EPS. Steroid therapy, including pulse therapy, was used to treat 84 patients (83.2%), and total parenteral nutrition was used to treat 80 patients (79.2%). Total intestinal enterolysis was performed in 31 patients (30.7%). Immunosuppressive agents were used in only 8 patients (7.9%). After 2 years, 100 patients (39.1%) were known to have died; 143 (55.9%) patients were known to still be alive. The most important problem for the living EPS patients was their mental condition, especially depressive state. However, only 22 of 133 patients (16.5%) were able to consult with a counselor in the hospital. A mental health support system should be provided to EPS patients in Japan.