Department of Nephrology and Dialysis, A. Manzoni Hospital, Via dell'Eremo 9/11, 23900, Lecco, Italy.
Department of Health Sciences, University of Milan-Bicocca, Milan, Italy.
J Nephrol. 2018 Feb;31(1):137-145. doi: 10.1007/s40620-016-0371-9. Epub 2016 Dec 24.
Encapsulating peritoneal sclerosis (EPS) is an uncommon but severe complication of peritoneal dialysis (PD). A reliable screening tool to identify patients at risk of developing or not EPS is currently not available. We aimed to evaluate whether the reduction in dialysate sodium concentration (sodium sieving) at 60 min (ΔD), during a peritoneal equilibration test with 3.86% glucose concentration (3.86%-PET) was able to early rule out patients who will not develop EPS.
Prospective controlled longitudinal (20-year) cohort study. All eligible incident PD patients attending the hospital underwent a 3.86%-PET during the first 3 months following start of PD and then once a year. The dip in ΔD and other factors were correlated with eventual EPS onset.
Of 161 incident PD patients, with a median PD duration of 37.8 (24.7-58.3) months and 64.1 (34.5-108.3) months of follow-up, 13 patients (8%) developed EPS at a median PD duration of 72.7 (56.6-109.4) months and 105.0 (76.4-143.2) months of follow-up. ΔD demonstrated the best sensitivity and specificity values, estimated by conventional receiver operating characteristic (ROC) curve analysis with an area under the curve (AUC) of 0.90, 0.83 and 0.85 at 1, 2 and 3 years before the onset of EPS, respectively. Multifactorial analysis showed that the most useful factors for predicting EPS were age at start of PD, duration of PD, small solutes transport (D/P) and ΔD; the AUC at 1, 2 and 3 years before the onset of EPS was, respectively, 0.97, 0.96 and 0.94, the positive predictive value being 0.48, 0.57 and 0.42, and the negative predictive value 1.0, 1.0 and 1.0.
It is possible to predict the occurrence and, better, the non-occurrence of EPS using simple parameters such as age at PD start, duration of PD, and parameters obtained by 3.86%-PET such as D/P and ΔD.
包裹性腹膜硬化症（EPS）是腹膜透析（PD）的一种罕见但严重的并发症。目前尚无可靠的筛查工具来识别有发生或不发生 EPS 风险的患者。我们旨在评估在 3.86%葡萄糖浓度的腹膜平衡试验（3.86%-PET）中，60 分钟时透析液钠浓度降低（钠筛）（ΔD）是否能够早期排除不会发生 EPS 的患者。
前瞻性对照纵向（20 年）队列研究。所有符合条件的新发病例 PD 患者在 PD 开始后的头 3 个月内接受 3.86%-PET 检查，然后每年检查一次。ΔD 及其他因素与最终发生 EPS 之间的相关性。
在 161 名新发病例 PD 患者中，中位 PD 持续时间为 37.8（24.7-58.3）个月，中位随访时间为 64.1（34.5-108.3）个月，13 名患者（8%）在中位 PD 持续时间为 72.7（56.6-109.4）个月和 105.0（76.4-143.2）个月时发生了 EPS。通过传统的接收者操作特征（ROC）曲线分析，ΔD 的灵敏度和特异性值最佳，ROC 曲线下面积（AUC）在 EPS 发病前 1、2 和 3 年分别为 0.90、0.83 和 0.85。多因素分析表明，预测 EPS 的最有用因素是 PD 起始年龄、PD 持续时间、小分子转运（D/P）和 ΔD；在 EPS 发病前 1、2 和 3 年的 AUC 分别为 0.97、0.96 和 0.94，阳性预测值分别为 0.48、0.57 和 0.42，阴性预测值分别为 1.0、1.0 和 1.0。
使用 PD 起始年龄、PD 持续时间和 3.86%-PET 获得的参数（如 D/P 和 ΔD）等简单参数，可以预测 EPS 的发生，更好的是，可以预测其不发生。
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