title: Preservation of peritoneal catheter for prevention of encapsulating peritoneal sclerosis.
abstract: We evaluated the usefulness of periodic abdominal irrigation through the peritoneal catheter preserved after termination of peritoneal dialysis (PD) to prevent encapsulating peritoneal sclerosis (EPS). The study group included 8 patients in whom PD had been terminated (mean age: 53.1 +/- 7.1 years; mean PD duration: 119.6 +/- 37.8 months). The abdominal cavity was periodically irrigated through the peritoneal catheter preserved after PD discontinuation. The appearance rate of cancer antigen 125 (CA125-AR), corrected by body surface area, was obtained every 3 months from 4-hour dwells. Based on the creatinine levels in 4-hour dwells and plasma, the dialysate-to-plasma creatinine (D/P Cr) was also obtained. Following abdominal irrigation for more than 12 months, the peritoneal catheter was removed and a biopsy specimen was taken from the peritoneum. The CA125-AR increased 3 months after PD discontinuation, but decreased thereafter. Encapsulating peritoneal sclerosis developed in 3 of 4 patients who lacked parietal mesothelial cells (PMCs) in a peritoneal specimen. In contrast, a good prognosis was obtained in 4 patients who had PMCs. The maximum value of the change in CA125-AR (delta CA125-AR, as compared with the value at PD discontinuation) was significantly greater in the PMC+ group than in the PMC- group (8.0 +/- 2.7 vs. 3.4 +/- 3.1, p < 0.001). The D/P Cr at catheter removal was lower in the PMC+ group than in the PMC- group (0.45 +/- 0.21 vs. 0.85 +/- 0.18, p < 0.05). Our findings suggest that periodic abdominal irrigation through the peritoneal catheter preserved after PD enhances the recovery of peritoneal damage. The CA125-AR value is a useful marker of viability and proliferation of PMCs.
authors.affiliation: Department of Artificial Organs, Akane Foundation, Tsuchiya General Hospital, Hiroshima, Japan.
authors.forename: Misaki
authors.initials: M
authors.lastname: Moriishi
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawanishi
authors.forename: Toru
authors.initials: T
authors.lastname: Kawai
authors.forename: Syunsake
authors.initials: S
authors.lastname: Takahashi
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hirai
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shishida
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Watanabe
authors.forename: Naoko
authors.initials: N
authors.lastname: Takahashi
mesh_terms: D034841:Abdominal Cavity; D018394:CA-125 Antigen / Q000378:metabolism; D003404:Creatinine / Q000378:metabolism; D015314:Dialysis Solutions / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010537:Peritoneum / Q000378:metabolism / Q000473:pathology*; D006435:Renal Dialysis; D012598:Sclerosis; D007507:Therapeutic Irrigation
chemical_list: D018394:CA-125 Antigen; D015314:Dialysis Solutions; D003404:Creatinine