title: The number of patients with severe encapsulating peritoneal sclerosis is decreasing in a large referral center in Germany.
abstract: BACKGROUND
  Encapsulating peritoneal sclerosis (EPS) is the most severe complication associated with long-term peritoneal dialysis (PD). Previous studies noticed a sharp decline in new patients with severe EPS. We investigated the number of severe EPS patients in our large referral center over almost 20 years.
  
  
  METHODS
  All late-stage EPS patients who underwent major surgery due to extensive symptoms caused by bowel obstruction (vomiting, abdominal pain, and weight loss) between March 1997 and end of December 2015 in our hospital were included in the present study. An index was calculated between the number of patients with severe EPS and the implanted PD catheters in our center.
  
  
  RESULTS
  Between 1979 and 2015, a total of 745 PD catheters were implanted in our center, with a steady increase in the numbers between 2003 and 2015. First patient with severe EPS was treated in 1998, then a rise in the number of patients with EPS was present in 2005. The number of patients with EPS peaked in the period of 2010-2012 (15 patients within 3 years). Afterward, both the absolute numbers and the index between the number of patients with severe EPS and the implanted catheters demonstrated a prominent reduction in the next 3-year period from 2013 to 2015.
  
  
  CONCLUSIONS
  Our data support the hypothesis that there seems to be a decrease of late-stage EPS incidence over the last years, but data about milder or asymptomatic patients are lacking. This should be kept in mind while giving the patients information about different renal replacement therapies at start of dialysis.
authors.affiliation: Division of General Medicine and Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kitterer
authors.affiliation: Nephrology Center Stuttgart, Stuttgart, Germany.
authors.forename: Niko
authors.initials: N
authors.lastname: Braun
authors.affiliation: Division of General Medicine and Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: M Dominik
authors.initials: MD
authors.lastname: Alscher
authors.affiliation: Division of Nephrology, University Hospital, Zurich, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Segerer
authors.affiliation: Division of General Medicine and Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Latus
keywords: EPS surgery; decrease of EPS incidence; encapsulating peritoneal sclerosis