title: Can EPS development be avoided with early interventions? The potential role of tamoxifen--a single-center study.
abstract: BACKGROUND
  Encapsulating peritoneal sclerosis (EPS) is a severe complication of peritoneal dialysis (PD). Identification of patients at high risk for EPS ("EPS-prone") and delivery of appropriate interventions might prevent its development. Our aim was to evaluate the clinical characteristics and outcomes of all EPS and EPS-prone patients diagnosed at our PD unit.
  
  
  METHODS
  For a 30-year period representing our entire PD experience, we retrospectively identified all patients with EPS (diagnosed according to International Society for Peritoneal Dialysis criteria) and all patients defined as EPS-prone because they met at least 2 established criteria (severe peritonitis, PD vintage greater than 3 years, severe hemoperitoneum, overexposure to glucose, and acquired ultrafiltration failure).
  
  
  RESULTS
  Of 679 PD patients, we identified 20 with EPS, for an overall prevalence of 2.9%. Mean age at diagnosis was 50.2 ± 16.4 years, with a median PD time of 77.96 months (range: 44.36 - 102.7 months) and a median follow-up of 30.91 months (range: 4.6 - 68.75 months). Of patients with EPS, 10 (50%) received tamoxifen, 10 (50%) received parenteral nutrition, and 2 (10%) underwent adhesiolysis, with 25% mortality related to EPS. Another 14 patients were identified as EPS-prone. Median follow-up was 54.05 months (range: 11.9 - 87.04 months). All received tamoxifen, and 5 (36%) received corticosteroids; none progressed to full EPS. We observed no differences in baseline data between the groups, but the group with EPS had been on PD longer (84 ± 53 months vs 39 ± 20 months, p = 0.002) and had a higher cumulative number of days of peritoneal inflammation from peritonitis (17.2 ± 11.1 days vs 9.8 ± 7.9 days, p = 0.015). Overall mortality was similar in the groups. The incidence of EPS declined during our three decades of experience (5.6%, 3.9%, and 0.3%).
  
  
  CONCLUSIONS
  Being a serious, life-threatening complication of PD, EPS requires high suspicion to allow for prompt diagnosis and treatment. Early detection of EPS-prone states and delivery of appropriate intervention might prevent EPS development. Tamoxifen seems to be a key strategy in prevention, but caution should be used in interpreting our results. Additional randomized controlled studies are needed.
authors.affiliation: Servicio de Nefrología, Hospital Universitario La Paz, IdiPAZ, Madrid; Servicio de Nefrología, Hospital San Pedro, Logroño; and Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
authors.forename: Erika
authors.initials: E
authors.lastname: De Sousa-Amorim
authors.affiliation: Servicio de Nefrología, Hospital Universitario La Paz, IdiPAZ, Madrid; Servicio de Nefrología, Hospital San Pedro, Logroño; and Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
authors.forename: Gloria
authors.initials: G
authors.lastname: Del Peso
authors.affiliation: Servicio de Nefrología, Hospital Universitario La Paz, IdiPAZ, Madrid; Servicio de Nefrología, Hospital San Pedro, Logroño; and Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
authors.forename: M Auxiliadora
authors.initials: MA
authors.lastname: Bajo
authors.affiliation: Servicio de Nefrología, Hospital Universitario La Paz, IdiPAZ, Madrid; Servicio de Nefrología, Hospital San Pedro, Logroño; and Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Alvarez
authors.affiliation: Servicio de Nefrología, Hospital Universitario La Paz, IdiPAZ, Madrid; Servicio de Nefrología, Hospital San Pedro, Logroño; and Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Ossorio
authors.affiliation: Servicio de Nefrología, Hospital Universitario La Paz, IdiPAZ, Madrid; Servicio de Nefrología, Hospital San Pedro, Logroño; and Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Gil
authors.affiliation: Servicio de Nefrología, Hospital Universitario La Paz, IdiPAZ, Madrid; Servicio de Nefrología, Hospital San Pedro, Logroño; and Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Bellon
authors.affiliation: Servicio de Nefrología, Hospital Universitario La Paz, IdiPAZ, Madrid; Servicio de Nefrología, Hospital San Pedro, Logroño; and Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Selgas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D056627:Peritoneal Fibrosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D011322:Primary Prevention / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013629:Tamoxifen / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D013629:Tamoxifen
keywords: EPS; EPS-prone states; Encapsulating peritoneal sclerosis; peritonitis; tamoxifen