title: Encapsulating peritoneal sclerosis in an Italian center: thirty year experience.
abstract: BACKGROUND
  Encapsulating peritoneal sclerosis (EPS) is a rare but life-threatening complication of peritoneal dialysis (PD). Its incidence and prevalence are still not clearly defined. No data exist on the prevalence of EPS in Italy.
  
  
  OBJECTIVE
  To evaluate the incidence and prevalence of EPS, and identify potential factors useful for prevention or early diagnosis of EPS.
  
  
  METHODS
  A retrospective study in patients starting PD between 1979 and 2013 in one Italian center. Data on demographics, occurrence of EPS, time on PD, peritoneal equilibration test, and therapy for EPS were gathered.
  
  
  RESULTS
  EPS occurred in 26/920 patients with a prevalence of 2.8 % and incidence of 1/105 patient-years. The prevalence increased with the time spent on PD: 0.4 % for PD duration <2 years, 3 % (2-4 years), 4 % (4-6 years), 6 % (6-8 years), 8 % (8-10 years), 18 % (10-12 years), 75 % (12-14 years), 67 % (>14 years). EPS prevalence was not higher in PD patients transplanted: 5/172 (2.9 %); only two of them (1.2 %) were diagnosed while with a functioning graft. In only one patient (0.6 %) was the diagnosis made during hemodialysis; the other 23 were diagnosed while still on PD. Mortality due to EPS was 38.5 %, and was associated with PD duration. Therapy with steroids reduced mortality [hazard ratio 0.047 (95 % CI: 0.008-0.273); p < 0.001].
  
  
  CONCLUSIONS
  In our experience the prevalence of EPS is low, but increases progressively with the duration of PD. The transfer to hemodialysis or transplantation does not appear to be a key factor for EPS. Therapy with steroids significantly improves the outcome.
authors.affiliation: Operative Unit of Nephrology, A. O. Spedali Civili of Brescia and University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy. valerio.vizzardi@spedalicivili.brescia.it.
authors.forename: Valerio
authors.initials: V
authors.lastname: Vizzardi
authors.affiliation: Operative Unit of Nephrology, A. O. Spedali Civili of Brescia and University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Sandrini
authors.affiliation: Operative Unit of Nephrology, A. O. Spedali Civili of Brescia and University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Zecchini
authors.affiliation: Operative Unit of Nephrology, A. O. Spedali Civili of Brescia and University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Ravera
authors.affiliation: Operative Unit of Nephrology, A. O. Spedali Civili of Brescia and University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Manili
authors.affiliation: Operative Unit of Nephrology, A. O. Spedali Civili of Brescia and University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cancarini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000401:mortality; D056627:Peritoneal Fibrosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013256:Steroids
keywords: Abdominal cocoon; Dialysis; Encapsulating peritoneal sclerosis; Peritoneal dialysis; Peritonitis