Peritoneal inflammation precedes encapsulating peritoneal sclerosis: results from the GLOBAL Fluid Study

Area of Science:

• Nephrology
• Immunology
• Gastroenterology

Background:

• Encapsulating peritoneal sclerosis (EPS) is a rare complication of long-term peritoneal dialysis (PD).
• PD-induced peritoneal membrane inflammation is linked to fibrosis and potentially EPS.
• This study investigates if higher peritoneal inflammation precedes EPS development.

Purpose of the Study:

• To determine if patients who develop EPS have higher levels of inflammatory cytokines in their peritoneal membrane during PD.
• To compare dialysate and plasma inflammatory markers between EPS cases and controls.

Main Methods:

• A nested case-control study within the GLOBAL Fluid Study identified 11 EPS cases and 26 controls.
• Dialysate and plasma samples were collected during peritoneal equilibration tests.
• Assays for interleukin-1β, tumor necrosis factor α, interferon-γ, and interleukin-6 were performed.

Main Results:

• Dialysate tumor necrosis factor α and interleukin-6 were significantly higher in EPS cases.
• Plasma interleukin-6 was also significantly elevated in EPS cases.
• No significant difference in peritoneal solute transport was observed between groups.

Conclusions:

• Patients who develop EPS exhibit elevated inflammatory cytokines in the peritoneal cavity during PD.
• Systemic inflammation appears to be increased, likely secondary to peritoneal inflammation.
• Current markers do not clearly distinguish EPS cases from controls during PD.