Otsuka Yasushi, Nakayama Masaaki, Ikeda Masato, Sherif Ali M, Yokoyama Keitaro, Yamamoto Hiroyasu, Kawaguchi Yoshindo
Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
Clin Exp Nephrol. 2005 Dec;9(4):315-319. doi: 10.1007/s10157-005-0384-5.
The epidemiological characteristics of encapsulating peritoneal sclerosis (EPS), such as its high incidence in patients with long-term peritoneal dialysis (PD) treatment, and the onset of EPS after patients are switched to hemodialysis (HD) may indicate an activated pathological process after PD withdrawal, especially in long-term PD patients. Accordingly, we aimed to observe changes in peritoneal function after the stoppage of PD, and to clarify the characteristic features of the patients at risk of EPS.
Thirty-three patients who were switched from continuous ambulatory peritoneal dialysis (CAPD) to HD were enrolled in this trial. Changes in the dialysate/plasma creatinine (D/P Cr) and CA125 levels in the effluent of the peritoneal equilibration test were observed for 6 months. Furthermore, each patient was followed-up for 36 months after PD withdrawal to monitor for the development of EPS.
D/P Cr decreased significantly, while CA125 levels tended to increase. Nine patients developed EPS during the follow-up period and they specifically showed significant increases of D/P Cr levels and significantly lower levels of CA125 at PD withdrawal. The accumulation of high transporters in the EPS group at 0 and 6 months after PD withdrawal was significant.
Peritoneal recovery may take place after withdrawal from PD treatment and such recover indicated by improvement of transport states and a rise of the CA125 level. The present study revealed that a high-transport state and lack of increase of CA125 in the effluent were associated with EPS development after PD withdrawal. This may suggest that the lack of peritoneal recovery after PD withdrawal is predictive for EPS development.
包裹性腹膜硬化（EPS）的流行病学特征，如在长期腹膜透析（PD）治疗患者中的高发病率，以及患者转为血液透析（HD）后EPS的发生，可能表明PD撤除后病理过程被激活，尤其是在长期PD患者中。因此，我们旨在观察PD停止后腹膜功能的变化，并阐明有EPS风险患者的特征。
本试验纳入了33例从持续性非卧床腹膜透析（CAPD）转为HD的患者。观察腹膜平衡试验流出液中透析液/血浆肌酐（D/P Cr）和CA125水平在6个月内的变化。此外，对每位患者在PD撤除后进行36个月的随访，以监测EPS的发生。
D/P Cr显著下降，而CA125水平有升高趋势。9例患者在随访期间发生了EPS，他们在PD撤除时D/P Cr水平显著升高，CA125水平显著降低。PD撤除后0个月和6个月时，EPS组高转运者的累积情况显著。
PD治疗撤除后腹膜可能会恢复，这种恢复表现为转运状态的改善和CA125水平的升高。本研究表明，高转运状态和流出液中CA125缺乏升高与PD撤除后EPS的发生有关。这可能表明PD撤除后腹膜缺乏恢复是EPS发生的预测因素。
