Yamamoto Ryo, Otsuka Yasushi, Nakayama Masaaki, Maruyama Yukio, Katoh Naohiko, Ikeda Masato, Yamamoto Hiroyasu, Yokoyama Keitaro, Kawaguchi Yoshindo, Matsushima Masato
Department of Kidney and Hypertension, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo 105-8461, Japan.
Clin Exp Nephrol. 2005 Jun;9(2):148-52. doi: 10.1007/s10157-005-0349-8.
The present study was conducted to clarify the clinical risk factors related to the development of encapsulating peritoneal sclerosis (EPS), which is one of the most serious complications in patients undergoing peritoneal dialysis (PD).
The records of 78 patients with a history of PD treatment, including 18 with EPS, were retrospectively analyzed (male/female, 51:27; age, 51.8 +/- 11.0 years; PD treatment, 94.1 +/- 42.7 months). The inclusion criteria were: duration of PD more than 24 months; 36-month follow up after discontinuation of PD; available data for dialysate-to-plasma creatinine ratio (D/P Cr), by fast peritoneal equilibration test within 3 months before PD discontinuation; and absence of EPS at PD discontinuation. Analytical parameters included age, sex, underlying renal disease, duration of PD, membrane transport state (higher transporter or lower transporter: D/P cr ratio more than or less than 0.75), number of episodes of peritonitis during PD treatment, performance of peritoneal lavage after PD discontinuation, and reasons for PD withdrawal (ultrafiltration failure, acute peritonitis, social matters).
Significant differences were noted regarding the PD duration, D/P cr, higher membrane transport state, and number of peritonitis episodes during PD. On receiver operating characteristic curves, the cutoff points for EPS were: D/P cr ratio, 0.74; number of peritonitis episodes, 2; and PD duration (months), 115.2. Multivariate analysis, employing the factors age, PD duration, higher membrane transport state, and number of peritonitis episodes, which were selected by stepwise analysis, identified the latter two factors as significant for the development of EPS (odds ratio [OR], 4.0; P = 0.046 and OR, 12.0; P = 0.049, respectively).
A higher transporter membrane state and the number of peritonitis episodes are factors contributing to the occurrence of EPS in patients who have experienced PD treatment.
本研究旨在阐明与包裹性腹膜硬化（EPS）发生相关的临床危险因素，EPS是腹膜透析（PD）患者最严重的并发症之一。
回顾性分析78例有PD治疗史的患者记录，其中18例患有EPS（男/女，51:27；年龄，51.8±11.0岁；PD治疗时间，94.1±42.7个月）。纳入标准为：PD持续时间超过24个月；PD停止后随访36个月；在PD停止前3个月内通过快速腹膜平衡试验获得透析液与血浆肌酐比值（D/P Cr）的可用数据；PD停止时无EPS。分析参数包括年龄、性别、基础肾病、PD持续时间、膜转运状态（高转运者或低转运者：D/P cr比值大于或小于0.75）、PD治疗期间腹膜炎发作次数、PD停止后腹膜灌洗情况以及PD退出原因（超滤失败、急性腹膜炎、社会因素）。
在PD持续时间、D/P cr、较高的膜转运状态以及PD期间腹膜炎发作次数方面存在显著差异。在接受者操作特征曲线上，EPS的截断点为：D/P cr比值，0.74；腹膜炎发作次数，2次；PD持续时间（月），115.2。多因素分析采用逐步分析选择的年龄、PD持续时间、较高的膜转运状态和腹膜炎发作次数等因素，确定后两个因素对EPS的发生具有显著意义（优势比[OR]分别为4.0；P = 0.046和OR，12.0；P = 0.049）。
较高的转运体膜状态和腹膜炎发作次数是经历PD治疗的患者发生EPS的因素。
