title: Single-center experience of encapsulating peritoneal sclerosis in patients on peritoneal dialysis for end-stage renal failure.
abstract: BACKGROUND
  Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD). It is characterized by a progressive, intra-abdominal, inflammatory process resulting in sheets of fibrous tissue that cover, bind, and constrict the viscera, thereby compromising the motility and function of the bowel. Although recent therapeutic approaches have been reported with variable success, the ability to detect reliably at an early stage patients at risk for EPS would be beneficial and allow treatment standardization. The aim of this study was to evaluate the clinical features of EPS and identify possible risk factors for its development in CAPD and APD patients.
  
  
  METHODS
  This was a review of all cases of EPS in a single center over the last 5 years.
  
  
  RESULTS
  There were 810 CAPD and APD patients, managed in our program over this period. We identified 27 cases of EPS, giving an overall of 3.3% in this population. The mean duration of CAPD before diagnosis of EPS was 72.6 +/- 39.7 months (range 16-172). Sixteen cases required surgical treatment and were classified as severe; others were treated conservatively (mild to moderate group). Ten patients received tamoxifen treatment with apparent benefit. The overall mortality rate was 29.6%. Eight patients from the severe group and the entire moderate group survived on hemodialysis or transplantation at 48.71 and 27.63 months follow-up, respectively. Peritonitis rates were not different between the 2 groups and peritoneal history was unremarkable compared to overall peritonitis rates in the unit. Data on small solute transport were not available in all patients in this retrospective analysis.
  
  
  CONCLUSIONS
  EPS is a serious, life-threatening complication of CAPD. Most cases had PD duration of more than 4 years. Careful monitoring by CT scans of the peritoneal membrane in patients beyond 5 years, and early catheter removal in patients with peritoneal thickening should be considered for long-term CAPD patients. Treatment with tamoxifen may be of benefit in these patients.
authors.affiliation: Department of Renal Medicine, Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, UK. Angela.Summers@cmmc.nhs.uk
authors.forename: Angela M
authors.initials: AM
authors.lastname: Summers
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Clancy
authors.forename: Fysal
authors.initials: F
authors.lastname: Syed
authors.forename: Nicola
authors.initials: N
authors.lastname: Harwood
authors.forename: Paul E C
authors.initials: PE
authors.lastname: Brenchley
authors.forename: Titus
authors.initials: T
authors.lastname: Augustine
authors.forename: Hany
authors.initials: H
authors.lastname: Riad
authors.forename: Alastair J
authors.initials: AJ
authors.lastname: Hutchison
authors.forename: Paul
authors.initials: P
authors.lastname: Taylor
authors.forename: Robert
authors.initials: R
authors.lastname: Pearson
authors.forename: Ram
authors.initials: R
authors.lastname: Gokal
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects* / Q000401:mortality; D010537:Peritoneum / Q000473:pathology*; D010538:Peritonitis / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D012598:Sclerosis; D015996:Survival Rate