Encapsulating peritoneal sclerosis in the new millennium: a national cohort study

Abstract

Background and objectives: The study aim was to establish the incidence and characterize all encapsulating peritoneal sclerosis (EPS) cases in patients treated by peritoneal dialysis (PD).

Design, setting, participants, & measurements: The patient cohort, which started PD from January 1, 2000, to December 31, 2007, was identified from the Scottish Renal Registry (n = 1238). Possible EPS cases were identified by the ten adult Scottish renal units. Patient records were examined to ensure cases met diagnostic criteria.

Results: Forty-six cases were identified; 19 had their first PD exposure after January 1, 2000. The rate was 1.5%, an incidence of 4.9 per 1000 person-years. The incidence increased with PD duration, with rates of 0, 0.6, 2.0, 3.5, 8.1, 8.8 and 5% at <1, 1 to 2, >2 to 3, >3 to 4, >4 to 5, >5 to 6 and >6 yr PD exposure, respectively. The median PD duration of EPS cases was 5.1 yr (interquartile range [IQR] 3.4 to 6.1 yr). At diagnosis, 12 (26%) were on PD and 33 (72%) were diagnosed <2 yr after PD stopped. The cases had a median of 3.3 episodes of peritonitis (range 0 to 20, IQR 1 to 4.5). Thirty (65%) had used 3.86% dextrose dialysate and 45 (98%) had used Extraneal. The mortality was 42% at 1 yr postdiagnosis with a median survival of 149 d (IQR 61 to 408 d).

Conclusions: The incidence reported in this study may be used to inform patients of the minimum risk of developing EPS on PD.

Figure 1.

Cumulative risk function of developing EPS according to days since first PD exposure between January 1, 2000, and December 31, 2007.

Figure 2.

(A) PD Duration: Non-EPS cohort first exposed to PD after January 1, 2000 (n = 1219). (B) PD Duration: EPS cases first exposed to PD after January 1, 2000 (n = 19).

Figure 3.

Kaplan-Meier survival plots of patients from start of PD for EPS cases (n = 19) and unaffected cohort (n = 1219).