Bertoli Silvio V, Musetti Claudio
U.O. Nefrologia e Dialisi, IRCCS Multimedica, Sesto San Giovanni (MI), Italy.
G Ital Nefrol. 2010 Sep-Oct;27(5):464-8.
Encapsulating peritoneal sclerosis (EPS) is a rare but severe disease with a mortality rate of 24%-54%, whose main risk factor is peritoneal dialysis (PD) (cumulative incidence 0.5%-7.3%). Although the role of the time spent on peritoneal dialysis is not completely clear, the available evidence suggests that peritoneal dialysis should not be discontinued early for the sake of reducing the EPS risk. We proposed a ''pro-con'' debate which confirmed that PD is not a time-limited technique. Nevertheless, in patients on long-term PD, surveillance of the peritoneal membrane is crucial. The development of EPS requires two ''hits'': first a chronic, inflammatory stimulus, which is typical of peritoneal dialysis, then a second event like PD interruption or kidney transplant. The main pharmacological and dialysis strategies that have been used as primary prevention did not show any significant results, and benefits are more likely to be achieved by reducing the peritoneal inflammation and better preservation of the membrane integrity, for example by means of more biocompatible PD solutions. Among the main surveillance and early diagnosis procedures other than the peritoneal equilibration test, the Ca-125 appearance rate and new tests that evaluate the peritoneal water transport seem to be promising.
包裹性腹膜硬化症（EPS）是一种罕见但严重的疾病，死亡率为24%-54%，其主要危险因素是腹膜透析（PD）（累积发病率为0.5%-7.3%）。尽管腹膜透析时长所起的作用尚不完全明确，但现有证据表明，不应为降低EPS风险而过早停止腹膜透析。我们发起了一场“正反方”辩论，证实腹膜透析并非有时间限制的技术。然而，对于长期进行腹膜透析的患者，监测腹膜至关重要。EPS的发生需要两个“触发因素”：首先是慢性炎症刺激，这是腹膜透析的典型特征，其次是如腹膜透析中断或肾移植等第二个事件。作为一级预防所采用的主要药物和透析策略并未显示出任何显著效果，通过减轻腹膜炎症和更好地保持膜的完整性（例如使用生物相容性更好的腹膜透析液）更有可能实现益处。在除腹膜平衡试验之外的主要监测和早期诊断程序中，Ca-125出现率以及评估腹膜水转运的新检测方法似乎很有前景。
