Encapsulating Peritoneal Sclerosis in Peritoneal Dialysis Patients After Kidney Transplantation

Area of Science:

• Nephrology
• Transplantation Surgery
• Gastroenterology

Background:

• Encapsulating peritoneal sclerosis (EPS) is a severe complication for chronic kidney disease (CKD) patients undergoing long-term peritoneal dialysis (PD).
• The risk of developing EPS is notably higher in patients following kidney transplantation after PD treatment.

Purpose of the Study:

• To identify and evaluate risk factors associated with the development of EPS in kidney transplant recipients with a history of PD.
• To analyze the impact of various clinical and treatment-related parameters on EPS incidence post-transplantation.

Main Methods:

• A retrospective analysis of 47 PD patients who underwent kidney transplantation between January 2008 and August 2015.
• Evaluation of patient demographics, PD treatment duration, HLA matching, immunosuppression, comorbidities, and clinical outcomes, comparing those with and without EPS.

Main Results:

• Higher C-reactive protein and serum ferritin levels, increased peritonitis episodes, and longer PD treatment duration were significantly associated with EPS.
• Continuous ambulatory peritoneal dialysis (CAPD), icodextrin-based PD regimens, cadaveric transplant recipients, and higher peritoneal transmittance rates were more common in EPS patients.
• Multivariate analysis indicated that prolonged PD duration and elevated ferritin levels independently increased EPS risk.

Conclusions:

• The duration of PD treatment, type of PD (CAPD), use of icodextrin, history of peritonitis, and peritoneal transport rate are significant predictors of EPS development post-kidney transplantation.
• These findings underscore the importance of monitoring these factors in CKD patients undergoing PD and subsequently receiving a transplant to mitigate EPS risk.