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Risk factors and preventive measures for encapsulating peritoneal sclerosis--Jikei experience 2002
Masaaki Nakayama1, Hiroyasu Yamamoto, Masato Ikeda
1Division of Kidney and Hypertension, Tokyo Jikei University School of Medicine, Tokyo, Japan.
Advances in Peritoneal Dialysis. Conference on Peritoneal Dialysis
|October 31, 2002
Summary
Long-term continuous ambulatory peritoneal dialysis (CAPD) increases the risk of encapsulating peritoneal sclerosis (EPS) after switching to hemodialysis. Early withdrawal from PD for high-transport patients may prevent EPS development.
Area of Science:
- Nephrology
- Pathology
Background:
- Encapsulating peritoneal sclerosis (EPS) incidence is rising, necessitating preventive strategies.
- Understanding EPS risk factors and patient characteristics is crucial for effective management.
Purpose of the Study:
- To investigate risk factors for EPS development.
- To characterize EPS patients' peritoneal morphology and function.
- To discuss EPS prevention protocols.
Main Methods:
- Observational study analyzing peritoneal morphology and function via peritoneal equilibration test.
- Evaluation of patients undergoing peritoneal dialysis (PD) and those transferred to hemodialysis.
- Development and discussion of a PD withdrawal protocol.
Main Results:
- Long-term continuous ambulatory peritoneal dialysis (CAPD) is a risk factor for EPS after PD to hemodialysis transfer.
- EPS patients typically exhibit a longstanding high-transport peritoneal state.
- EPS involves peritoneal collagen thickening, neoangiogenesis, and myofibroblastic transformation.
Conclusions:
- A withdrawal protocol for long-term CAPD patients with high-transport states is proposed for EPS prevention.
- Peritoneal lavage post-PD withdrawal may benefit some patients; its efficacy requires further study.
- Pharmacologic intervention, such as prednisolone, may be needed for persistent high transporters with inflammation.