[Encapsulating peritonitis during continuous ambulatory peritoneal dialysis. A physiopathologic hypothesis].

Area of Science:

• Nephrology
• Gastroenterology
• Pathology

Background:

• Continuous ambulatory peritoneal dialysis (CAPD) is a common treatment for end-stage renal disease.
• Peritonitis is a known complication of CAPD, potentially leading to long-term complications.
• Sclerosing encapsulating peritonitis (SEP) is a severe complication characterized by peritoneal fibrosis.

Observation:

• A patient on CAPD for 4 years using lactate-buffered dialysate developed recurrent peritonitis.
• Initial signs included decreased ultrafiltration and increased glucose absorption, with peritoneal biopsy showing mesothelial damage.
• Later, altered glucose equilibration curves indicated poor ultrafiltration and slow glucose absorption, suggesting SEP.

Findings:

• The patient was diagnosed with sclerosing encapsulating peritonitis confirmed during laparotomy.
• The study suggests prolonged mesothelial layer alteration may be an early stage of SEP.
• Two types of filtration loss were observed: hyperpermeability (Type I) and hypopermeability (Type II).

Implications:

• Prompt discontinuation of CAPD is recommended upon observing Type I filtration loss (hyperpermeability) to allow recovery.
• Failure to intervene may lead to Type II filtration loss (hypopermeability) due to adhesions or encapsulation, potentially necessitating dialysis cessation.
• Understanding the progression of peritoneal membrane damage is vital for managing CAPD patients and preventing SEP.