Fibrin degradation products are a useful marker for the risk of encapsulating peritoneal sclerosis.
Encapsulating peritoneal sclerosis (EPS) is the most serious fatal complication of peritoneal dialysis (PD). Previous studies have indicated the importance of PD duration in the risk of EPS. Pathologic factors may include proliferative neoangiogenesis of the peritoneum and peritoneal hyperpermeability to macromolecules. Because the main component of EPS capsules is fibrin, early detection of the appearance of fibrin may contribute to preventing EPS. For this purpose, measurement of fibrin degradation products (FDPs) in peritoneal effluent may be useful. We therefore examined the relationship between FDP levels and the development of EPS, and the effect of steroid administration. Our study included 237 patients who had undergone PD between January 2002 and April 2006. Mean duration of PD in these patients was 418.4 +/- 32.2 months (range: 1 - 149.8 months). The fast peritoneal equilibration test (PET) was performed every 6 months, and simultaneously, we determined the FDP level in the effluent of the 4-hour PET dwell (eFDP). Patients with rapidly increasing eFDP levels were administered prednisolone therapy. We obtained eFDP levels a total of 1335 times in 237 patients. The mean eFDP level was 9.0 +/- 12.1 ng/mL (range: 0 - 137.9 ng/mL), and we found that eFDP was correlated with the dialysate-to-plasma ratio of creatinine (D/P Cr) on PET, but not with duration of PD. In 16 patients, eFDP was greater than 40 ng/mL, and D/P Cr on PET ranged from 0.50 to 0.93. In 7 of these 16 patients, the administration of 5 - 30 mg of prednisolone daily reduced the eFDP level, but not to a normal level, and 1 of the 16 developed EPS. Effluent FDP in a useful marker for the risk of EPS. Our results suggest that intensive prednisolone therapy for patients with high eFDP may forestall EPS development.
Moriishi
Misaki
M
Tsuchiya General Hospital, Hiroshima, Japan. usagi@tsuchiya-hp.jp
Kawanishi
Hideki
H
D003404:Creatinine / Q000378:metabolism; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010532:Peritoneal Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D010537:Peritoneum / Q000378:metabolism; D011239:Prednisolone / Q000627:therapeutic use; D012307:Risk Factors; D012598:Sclerosis; D001613:beta 2-Microglobulin / Q000378:metabolism
D005338:Fibrin Fibrinogen Degradation Products; D005938:Glucocorticoids; D001613:beta 2-Microglobulin; D011239:Prednisolone; D003404:Creatinine