[Peritoneal dialysis: a time-limited therapy because of encapsulating peritoneal sclerosis? No, but due attention is...

Encapsulating peritoneal sclerosis (EPS) is a rare complication that occurs mainly in patients on long-term peritoneal dialysis (PD). It is characterized by marked thickening of the peritoneal membrane with signs of inflammation. Vascular occlusions and microscopic and macroscopic calcifications are frequent. Signs of acute and chronic inflammation are always present with leukocyte infiltration, microabscesses and giant cells of macrophage origin. The triggering factor in patients on PD may be an acute inflammatory process such as an episode of severe peritonitis. After discontinuation of PD for kidney transplant, immunosuppressive therapy with calcineurin inhibitors, which have profibrotic properties, may lead to EPS. After a switch from PD to hemodialysis, EPS may be induced by the inability to remove proinflammatory factors, cytokines, coagulation factors and fibrin from the peritoneal cavity. These considerations are not meant to imply a PD ''expiry date'' but should prompt nephrologists to be more careful in treating PD patients, using more biocompatible solutions and monitoring (through clinical observation and diagnostic evaluation) patients on long-term PD to avoid the appearance of this rare but dreaded complication.