Nakayama Masaaki, Miyazaki Masanobu, Honda Kazuho, Kasai Kenji, Tomo Tadashi, Nakamoto Hidetomo, Kawanishi Hideki
Tohoku University Graduate School of Medicine, Sendai, Japan; Fukushima Medical University School of Medicine, Fukushima, Japan; Miyazaki Clinic, Nagasaki, Japan; Tokyo Women's Medical University School of Medicine, Tokyo, Japan; Fuji City General Hospital, Fuji, Japan; Oita University School of Medicine, Oita, Japan; Saitama Medical University, Saitama, Japan; and Tsuchiya General Hospital, Hiroshima, Japan Tohoku University Graduate School of Medicine, Sendai, Japan; Fukushima Medical University School of Medicine, Fukushima, Japan; Miyazaki Clinic, Nagasaki, Japan; Tokyo Women's Medical University School of Medicine, Tokyo, Japan; Fuji City General Hospital, Fuji, Japan; Oita University School of Medicine, Oita, Japan; Saitama Medical University, Saitama, Japan; and Tsuchiya General Hospital, Hiroshima, Japan.
Tohoku University Graduate School of Medicine, Sendai, Japan; Fukushima Medical University School of Medicine, Fukushima, Japan; Miyazaki Clinic, Nagasaki, Japan; Tokyo Women's Medical University School of Medicine, Tokyo, Japan; Fuji City General Hospital, Fuji, Japan; Oita University School of Medicine, Oita, Japan; Saitama Medical University, Saitama, Japan; and Tsuchiya General Hospital, Hiroshima, Japan.
Perit Dial Int. 2014 Nov-Dec;34(7):766-74. doi: 10.3747/pdi.2013.00074. Epub 2014 Feb 4.
Encapsulating peritoneal sclerosis (EPS) is a serious complication of peritoneal dialysis (PD). Over the past decade in Japan, a multidisciplinary approach has been adopted to minimize the incidence and improve outcomes of EPS. This strategy includes planned PD discontinuation for high-risk patients and the introduction of biocompatible solutions. This study examined the current clinical status of EPS in representative PD centers in Japan.
DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: Patients (n = 1,338) from 55 PD centers in Japan who were using neutral-pH solutions from the initiation of therapy (mean age, 62 years; median PD duration, 32 months; concomitant use of icodextrin, 35.2%; PD and hemodialysis combination therapy, 12.2%) were assessed every 6 months to ascertain the reasons for PD discontinuation and the development of EPS development. Outcomes were also recorded. The study period was from November 2008 to March 2012.
There were 727 patients who discontinued PD, including 163 deaths. Among all causes of PD withdrawal except for death, planned PD discontinuation to avoid EPS was utilized in 58 cases (7.1% in total). The strategy was increasingly utilized in proportion to the duration of PD: 0.5% for patients undergoing PD for < 3 years, 0.6% for patients undergoing PD for 5 years, 14.7% for patients undergoing PD for 8 years, and 35.5% for patients undergoing PD for > 8 years. Fourteen patients developed EPS (three cases after PD), which corresponded with an overall incidence of 1.0%. The incidence according to the duration of PD was 0.3% for PD < 3 years, 0.6% for PD = 5 years, 2.3% for PD = 8 years, and 1.2% for PD > 8 years. In terms of therapy, 11 patients were treated with prednisolone (PSL), and surgical enterolysis was utilized in two cases. Complete remission of abdominal symptoms was achieved in twelve patients (85.7%), and three died due to EPS (mortality rate of 21.4%).
Use of the multidisciplinary approach described above reduces the risk of the development of EPS according to PD duration. In cases of de novo EPS cases in Japan, this strategy can also attenuate the clinical course of the condition.
包裹性腹膜硬化（EPS）是腹膜透析（PD）的一种严重并发症。在过去十年间，日本采用了多学科方法以尽量降低EPS的发生率并改善其预后。该策略包括为高危患者有计划地停止PD治疗以及引入生物相容性溶液。本研究调查了日本代表性PD中心EPS的当前临床状况。
设计、设置、参与者与测量：来自日本55个PD中心的患者（n = 1338例），这些患者从治疗开始就使用中性pH值溶液（平均年龄62岁；PD中位治疗时间32个月；同时使用艾考糊精的比例为35.2%；PD与血液透析联合治疗的比例为12.2%），每6个月进行评估，以确定停止PD治疗的原因及EPS的发生情况。同时记录结果。研究时间段为2008年11月至2012年3月。
有727例患者停止了PD治疗，其中163例死亡。在除死亡之外的所有PD撤机原因中，为避免EPS而有计划地停止PD治疗的有58例（占总数的7.1%）。该策略的使用比例随着PD治疗时间的延长而增加：PD治疗时间<3年的患者中为0.5%，PD治疗5年的患者中为0.6%，PD治疗8年的患者中为14.7%，PD治疗>8年的患者中为35.5%。14例患者发生了EPS（3例在PD治疗后），总体发生率为1.0%。根据PD治疗时间的发生率分别为：PD<3年时为0.3%，PD = 5年时为0.6%，PD = 8年时为2.3%，PD>8年时为1.2%。在治疗方面，11例患者接受了泼尼松龙（PSL）治疗，2例患者接受了手术肠粘连松解术。12例患者（85.7%）腹部症状完全缓解，3例因EPS死亡（死亡率为21.4%）。
上述多学科方法的应用可根据PD治疗时间降低EPS发生的风险。在日本新发EPS病例中，该策略也可减轻病情的临床进程。
