Encapsulating peritoneal sclerosis: a rare, serious but potentially curable complication of peritoneal dialysis-experience of a referral centre in Germany.
BACKGROUND
Chronic peritoneal dialysis (PD) can be complicated by encapsulating peritoneal sclerosis (EPS), the most severe complication associated with long-term PD.


METHODS
In this study, we retrospectively analysed 49 EPS patients regarding clinical presentation, histopathological findings, treatment and long-term clinical outcome at our referral centre. Patients were divided into two clinical categories: severe and mild/moderate.


RESULTS
All patients in the severe group and most patients in the mild/moderate group had symptoms consistent with EPS. The most common computed tomographic findings were peritoneal thickening in both groups. Small bowel dilatation was frequently present in the severe group. The time of onset of symptoms consistent with EPS to the surgical procedure was median 5 months with an inter-quartile range of 2-12 months in the severe group. To date, 25 of 31 patients in the severe group (follow-up 45.6 ± 39.0 months after surgery) are alive. In the mild/moderate group, 8 of 11 patients are alive (follow-up 41.6 ± 21.6 months). The histological features were consistent with EPS in all biopsies.


CONCLUSIONS
The outcome of patients even with severe EPS is not worse. It is a precondition that these patients are treated in specialized referral centres. The time of first clinical symptoms consistent with EPS to requirement of surgery is very short. Earlier diagnosis of the disease is mandatory, even in asymptomatic patients.
Department of Internal Medicine, Division of Nephrology, Robert-Bosch Hospital, Stuttgart, Germany. Joerg.latus@rbk.de
Joerg
J
Latus
Christoph
C
Ulmer
Peter
P
Fritz
Bianka
B
Rettenmaier
Dagmar
D
Biegger
Thomas
T
Lang
German
G
Ott
Christoph
C
Scharpf
Martin
M
Kimmel
Wolfgang
W
Steurer
M Dominik
MD
Alscher
Niko
N
Braun
D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D056627:Peritoneal Fibrosis / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D015996:Survival Rate