Preservation of peritoneal catheter for prevention of encapsulating peritoneal sclerosis

We evaluated the usefulness of periodic abdominal irrigation through the peritoneal catheter preserved after termination of peritoneal dialysis (PD) to prevent encapsulating peritoneal sclerosis (EPS). The study group included 8 patients in whom PD had been terminated (mean age: 53.1 +/- 7.1 years; mean PD duration: 119.6 +/- 37.8 months). The abdominal cavity was periodically irrigated through the peritoneal catheter preserved after PD discontinuation. The appearance rate of cancer antigen 125 (CA125-AR), corrected by body surface area, was obtained every 3 months from 4-hour dwells. Based on the creatinine levels in 4-hour dwells and plasma, the dialysate-to-plasma creatinine (D/P Cr) was also obtained. Following abdominal irrigation for more than 12 months, the peritoneal catheter was removed and a biopsy specimen was taken from the peritoneum. The CA125-AR increased 3 months after PD discontinuation, but decreased thereafter. Encapsulating peritoneal sclerosis developed in 3 of 4 patients who lacked parietal mesothelial cells (PMCs) in a peritoneal specimen. In contrast, a good prognosis was obtained in 4 patients who had PMCs. The maximum value of the change in CA125-AR (delta CA125-AR, as compared with the value at PD discontinuation) was significantly greater in the PMC+ group than in the PMC- group (8.0 +/- 2.7 vs. 3.4 +/- 3.1, p < 0.001). The D/P Cr at catheter removal was lower in the PMC+ group than in the PMC- group (0.45 +/- 0.21 vs. 0.85 +/- 0.18, p < 0.05). Our findings suggest that periodic abdominal irrigation through the peritoneal catheter preserved after PD enhances the recovery of peritoneal damage. The CA125-AR value is a useful marker of viability and proliferation of PMCs.