title: Persistent sterile peritoneal inflammation after catheter removal for refractory bacterial peritonitis predicts full-blown encapsulating peritoneal sclerosis.
abstract: BACKGROUND
  Encapsulating peritoneal sclerosis (EPS) is the most serious complication of peritoneal dialysis, having high morbidity and mortality. To improve outcomes, early diagnosis is needed to direct treatment during the early inflammatory phase. However, in the early inflammatory phase, clinical features are nonspecific, and no reliable diagnostic criteria have been established. Because bacterial peritonitis and termination of dialysis are two important risk factors triggering the progression of EPS, patients with refractory bacterial peritonitis necessitating dialysis catheter removal are at particularly high risk of developing EPS. Many of these patients might indeed experience non-resolving sterile peritonitis (probably the inflammatory phase of EPS) before progression to full-blown disease (that is, the presence of intestinal obstruction). We undertook a retrospective study to compare, in this particular situation, the clinical characteristics of patients with or without sterile peritoneal inflammation, assessing their clinical outcomes in terms of short-term mortality and the chance of developing full-blown EPS.
  
  
  METHODS
  Our retrospective review included 62 patients whose dialysis catheter was removed because of refractory peritonitis between January 2005 and December 2010.
  
  
  RESULTS
  Of the 62 patients identified, 39 (63%) had persistent sterile peritoneal inflammation ("high-risk" group, n = 39), and 23 (37%) had resolution of inflammation without significant intra-abdominal collection after catheter withdrawal ("control" group, n = 23). Compared with the control group, the high-risk group had a significantly longer PD duration (71.6 ± 43.3 months vs 42.3 ± 29.9 months, p = 0.003), a higher dialysate-to-plasma ratio (D/P) of creatinine (0.768 ± 0.141 vs 0.616 ± 0.091, p = 0.004), and a higher computed tomography score for EPS (7.69 ± 2.98 vs 1.00 ± 1.00, p < 0.001). During the 6-month study period, the high-risk group had a higher chance of developing full-blown EPS (31% vs 0%, p = 0.002) and a higher 6-month all-cause mortality (36% vs 4.3%, p = 0.004).
  
  
  CONCLUSIONS
  Persistent sterile peritoneal inflammation was common after dialysis catheter removal for refractory bacterial peritonitis, and the patients with such inflammation were at high risk of progression to full-blown EPS.
authors.affiliation: Renal Unit,1 Department of Medicine and Geriatrics, and Department of Radiology,2 Kwong Wah Hospital, Hong Kong SAR, PR China.
authors.forename: Yuk-Yi
authors.initials: YY
authors.lastname: Wong
authors.forename: Ping-Nam
authors.initials: PN
authors.lastname: Wong
authors.forename: Siu-Ka
authors.initials: SK
authors.lastname: Mak
authors.forename: Shuk-Fan
authors.initials: SF
authors.lastname: Chan
authors.forename: Yuen-Yi
authors.initials: YY
authors.lastname: Cheuk
authors.forename: Lo-Yi
authors.initials: LY
authors.lastname: Ho
authors.forename: Kin-Yee
authors.initials: KY
authors.lastname: Lo
authors.forename: Man-Wai
authors.initials: MW
authors.lastname: Lo
authors.forename: Kwok-Chi
authors.initials: KC
authors.lastname: Lo
authors.forename: Gensy Mei-Wah
authors.initials: GM
authors.lastname: Tong
authors.forename: Andrew Kui-Man
authors.initials: AK
authors.lastname: Wong
mesh_terms: D001424:Bacterial Infections / Q000150:complications / Q000628:therapy*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D020878:Device Removal / Q000009:adverse effects*; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D056627:Peritoneal Fibrosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D010537:Peritoneum / Q000473:pathology; D010538:Peritonitis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
keywords: Catheter removal; encapsulating peritoneal sclerosis; mortality; refractory peritonitis
references.citation: Perit Dial Int. 2010 Mar-Apr;30(2):163-9
references.pmid: 20124195
references.citation: Kidney Int. 2005 Nov;68(5):2381-8
references.pmid: 16221244
references.citation: Adv Perit Dial. 2006;22:94-8
references.pmid: 16983948
references.citation: Clin Radiol. 2007 Aug;62(8):732-7
references.pmid: 17604760
references.citation: Nephrol Dial Transplant. 1998 Jan;13(1):154-9
references.pmid: 9481732
references.citation: Clin J Am Soc Nephrol. 2009 Jul;4(7):1222-9
references.pmid: 19541815
references.citation: Perit Dial Int. 2011 May-Jun;31(3):269-78
references.pmid: 21454391
references.citation: Perit Dial Int. 2009 Nov-Dec;29(6):595-600
references.pmid: 19910558
references.citation: Perit Dial Int. 2005 Apr;25 Suppl 4:S19-29
references.pmid: 16300269
references.citation: Nephrol Dial Transplant. 2007 Feb;22(2):560-7
references.pmid: 17035369
references.citation: Lancet. 1983 Jul 9;2(8341):113-4
references.pmid: 6134956
references.citation: Nephrol Dial Transplant. 2009 Oct;24(10):3209-15
references.pmid: 19211652
references.citation: Nephrol Dial Transplant. 2011 Apr;26(4):1374-9
references.pmid: 20810453
references.citation: Am J Kidney Dis. 2004 Oct;44(4):729-37
references.pmid: 15384025
references.citation: J Am Soc Nephrol. 2006 Sep;17(9):2591-8
references.pmid: 16885406
references.citation: Clin J Am Soc Nephrol. 2008 Nov;3(6):1702-10
references.pmid: 18667742
references.citation: Perit Dial Int. 2005 Apr;25 Suppl 4:S30-8
references.pmid: 16300270
references.citation: Perit Dial Int. 2011 Jan-Feb;31(1):34-8
references.pmid: 20448239
references.citation: Perit Dial Int. 2009 Sep-Oct;29(5):517-22
references.pmid: 19776044
references.citation: Perit Dial Int. 2008 Jul-Aug;28(4):352-60
references.pmid: 18556377