[Peritoneal dialysis: a time-limited therapy because of encapsulating peritoneal sclerosis?]

Encapsulating peritoneal sclerosis (EPS) is a rare but severe disease with a mortality rate of 24%-54%, whose main risk factor is peritoneal dialysis (PD) (cumulative incidence 0.5%-7.3%). Although the role of the time spent on peritoneal dialysis is not completely clear, the available evidence suggests that peritoneal dialysis should not be discontinued early for the sake of reducing the EPS risk. We proposed a ''pro-con'' debate which confirmed that PD is not a time-limited technique. Nevertheless, in patients on long-term PD, surveillance of the peritoneal membrane is crucial. The development of EPS requires two ''hits'': first a chronic, inflammatory stimulus, which is typical of peritoneal dialysis, then a second event like PD interruption or kidney transplant. The main pharmacological and dialysis strategies that have been used as primary prevention did not show any significant results, and benefits are more likely to be achieved by reducing the peritoneal inflammation and better preservation of the membrane integrity, for example by means of more biocompatible PD solutions. Among the main surveillance and early diagnosis procedures other than the peritoneal equilibration test, the Ca-125 appearance rate and new tests that evaluate the peritoneal water transport seem to be promising.