Long-term peritoneal dialysis and encapsulating peritoneal sclerosis in children

Abstract

Encapsulating peritoneal sclerosis (EPS) is the most serious complication of long-term peritoneal dialysis (PD), with a mortality rate that exceeds 30%. There have been many reports of the incidence of EPS being strongly correlated to the duration of PD. Patients on PD for longer than 5 years, and especially those receiving this treatment for more than 8 years, should undergo careful and repeated surveillance for risk factors associated with the development of EPS. The development of ultrafiltration failure, a high dialysate/plasma creatinine ratio, as determined by the peritoneal equilibration test, peritoneal calcification, a persistently elevated C-reactive protein level, and severe peritonitis in patients on PD for longer than 8 years are signals that should prompt the clinician to consider terminating PD as a possible means of preventing the development of EPS. The impact of the newer, biocompatible PD solutions on the incidence of EPS has not yet been determined.

Fig. 1

Patient survival rate in children initiating peritoneal dialysis before (broken line) and during/after 1992 (solid line). Cited from Honda [12]

Fig. 2

Technique survival rate in children initiating peritoneal dialysis before (solid line) and during/after 1992 (broken line). Cited from Honda [12]