Kidney Center, Shirasagi Hospital, Osaka, Japan.
Perit Dial Int. 2010 May-Jun;30(3):343-52. doi: 10.3747/pdi.2008.00273. Epub 2010 Mar 25.
Severe peritoneal injury and encapsulating peritoneal sclerosis (EPS) as complications of long-term peritoneal dialysis (PD) are issues of concern. The usefulness of peritoneal lavage after withdrawal of PD and the risk factors for EPS have not been addressed until now. Little is known about mesothelial cell area (MCA) in the effluent as a marker of peritoneal injury. In the present study, we investigated the clinical significance of peritoneal lavage after PD withdrawal and tried to clarify the risk factors related to MCA, with the aim of preventing EPS. We also developed an algorithm for the clinical management of long-term PD patients.
We assigned 247 PD patients to one of two cohorts after PD withdrawal: a non-lavage group (73 patients) and a lavage group (174 patients). To clarify the risk factors, we studied these potential predictors: PD duration, dialysate-to-plasma ratio of creatinine (D/P Cr) at the time of PD withdrawal, frequency of peritoneal lavage, type of PD or lavage solution, MCA at the time of PD withdrawal ("PD area"), and MCA at the time of peritoneal lavage withdrawal or censoring ("LA area"). Recurrent intestinal obstruction was defined as the main manifestation of EPS. Diagnostic performance and cut-off values were then calculated for the selected risk factors.
The overall incidence of EPS was significantly lower in the lavage group, at 6.9% (5.2% during lavage and 2.5% after lavage), than in the non-lavage group, at 15.1%. The risk factors and cut-off values were PD area (350 µm(2)) and PD duration (78 months) for the non-lavage group; and PD area (350 µm(2)) and LA area (320 µm(2)) for the lavage group. Patients with a PD duration of 78 months or more and a PD area of 350 µm(2) or more were defined as high-risk patients in the non-lavage group (risk ratio: 11.14), and patients with a PD area of 350 µm(2) or more and an LA area of 320 µm(2) or more were defined as high-risk patients in the lavage group (risk ratio: 10.43).
Peritoneal lavage is effective in reducing the incidence of EPS after PD withdrawal. The PD duration and MCA are significant risk factors, and these markers are useful for classifying patients into low- and high-risk groups for the development of EPS.
长期腹膜透析（PD）导致的严重腹膜损伤和包裹性腹膜硬化症（EPS）是令人关注的问题。目前尚未研究 PD 停止后腹膜灌洗的作用，以及 EPS 的相关危险因素。尚不清楚灌洗流出液中间皮细胞面积（MCA）作为腹膜损伤的标志物的意义。本研究旨在探讨 PD 停止后腹膜灌洗的临床意义，并试图阐明与 MCA 相关的危险因素，以期预防 EPS。我们还开发了一种针对长期 PD 患者的临床管理算法。
PD 停止后，我们将 247 名 PD 患者分为两组：非灌洗组（73 例）和灌洗组（174 例）。为了明确危险因素，我们研究了这些潜在的预测因素：PD 持续时间、PD 停止时的肌酐透析液-血浆比（D/P Cr）、腹膜灌洗频率、PD 类型或灌洗液、PD 停止时的 MCA（“PD 面积”）以及腹膜灌洗停止或随访时的 MCA（“LA 面积”）。复发性肠梗阻定义为 EPS 的主要表现。然后计算选定危险因素的诊断性能和截断值。
灌洗组的总体 EPS 发生率明显低于非灌洗组（6.9%，灌洗时为 5.2%，灌洗后为 2.5%）。非灌洗组的危险因素和截断值为 PD 面积（350 µm²）和 PD 持续时间（78 个月）；灌洗组的危险因素和截断值为 PD 面积（350 µm²）和 LA 面积（320 µm²）。PD 持续时间≥78 个月和 PD 面积≥350 µm²的患者被定义为非灌洗组的高危患者（风险比：11.14），PD 面积≥350 µm²和 LA 面积≥320 µm²的患者被定义为灌洗组的高危患者（风险比：10.43）。
PD 停止后腹膜灌洗可有效降低 EPS 的发生率。PD 持续时间和 MCA 是重要的危险因素，这些标志物可用于将患者分为发生 EPS 的低危和高危人群。
