NDT Advance Access originally published online on February 11, 2009
Nephrology Dialysis Transplantation 2009 24(10):3209-3215; doi:10.1093/ndt/gfp008
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The Pan-Thames EPS study: treatment and outcomes of encapsulating peritoneal sclerosis
1 West London Renal and Transplant Centre 2 Royal Free Hospital 3 King's College Hospital, London 4 Basildon Hospital, Basildon 5 Royal London Hospital, London 6 Lister Hospital, Stevenage 7 St Helier Hospital, Carshalton 8 Southend Hospital, Southend 9 Canterbury Hospital, Canterbury 10 Guy's Hospital, London, UK
Correspondence and offprint requests to: Gowrie Balasubramaniam; E-mail: gowrie{at}doctors.org.uk
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Abstract |
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Background. Encapsulating peritoneal sclerosis (EPS) is a disease process that can occur as a complication of peritoneal dialysis (PD). The aim of this study was to make a general assessment of the clinical features, diagnosis, management and outcome of PD-related EPS cases from London and South-East England.
Methods. Questionnaires were sent to 11 PD units in March 2007; cases were identified retrospectively. Outcome data on surviving patients were collected in March 2008.
Results. A total of 111 patients were identified; the mean time on PD was 82 months (range 8–247). Mortality increased with length of time on PD, being 42% at <3 years (n = 12), 32% at 3–4 years (n = 19), 61% at 5–6 years (n = 31), 54% at 7–8 years (n = 24), 75% at 9–10 years (n = 8) and 59% at >10 years (n = 17). Twelve patients had no previous peritonitis episodes, 28 had one previous episode, 30 had two previous episodes and 33 had three or more previous episodes. Of the patients with PD details available, 41/63 were high (>0.81) transporters and 44/71 had ultrafiltration <1 l/24 h, but 7/63 were low average transporters (0.5–<0.65) and 27/71 had ultrafiltration >1 l/24 h and a few had significant residual renal function. Sixty-five (59%) patients had their PD discontinued prior to diagnosis (51 HD; 14 transplanted). CT scans were performed on 91 patients and laparotomy on 47 patients. Drug treatment consisted of tamoxifen, immunosuppression or both. The median survival was 15 months in patients treated with tamoxifen (n = 17), 12 months in patients treated with immunosuppression (n = 24) and 21 months in patients who received both (n = 13), against 13 months (n = 46) in patients who received no specific treatment. Adhesionolysis was performed in 5 patients, and 39 patients were given parenteral nutrition. The overall mortality was 53% with a median survival of 14 months and a median time to death of 7 months.
Conclusion. This is one of the largest cohorts of patients with EPS in the literature. Long-term survival occurred in over 50%, regardless of the various treatments strategies undertaken by the centres.
Keywords: encapsulating peritoneal sclerosis; peritoneal dialysis; multicentre retrospective study; treatment
Received for publication: 3. 8.08
Accepted in revised form: 5. 1.09
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