Koc Yener, Basturk Taner, Sakaci Tamer, Caglayan Feyza B, Hasbal Nuri B, Ahbap Elbis, Sevinc Mustafa, Sinangil Ayse, Ucar Zuhal A, Nazif Perin, Islam Mahmut, Unsal Abdulkadir
Department of Nephrology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey -
Department of Nephrology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Minerva Urol Nefrol. 2018 Aug;70(4):429-436. doi: 10.23736/S0393-2249.18.03057-6. Epub 2018 Feb 22.
Encapsulated peritoneal sclerosis (EPS) is a multifactorial chronic intra-abdominal inflammatory disorder affecting the peritoneum diffusely. The aim of this study was to evaluate the rates of EPS in our peritoneal dialysis (PD) population, to perform a general assessment of the clinical presentation and to determine the outcome of affected patients and risk factors.
The medical records of consecutive 384 patients who started PD therapy between January 2001 and November 2016 were evaluated. Socio-demographic characteristics, comorbidities, PD therapy details and infectious complications were recorded. Medical records were examined to make sure that the cases met the ISPD criteria for EPS diagnosis including clinical features and either radiological and/or histopathological confirmation. Patients diagnosed with EPS were identified, and the incidence, clinical presentation, treatments and recent status of the patients were reviewed. Factors that might be associated with EPS formation and mortality were investigated.
Two hundred one of 384 patients were female, mean age was 45.9±15.6 years and mean PD follow up time were 42.6±35 months. EPS was developed in 26 patients and EPS development rate was 6.7%. PD follow-up period and duration of hypertonic solution usage were longer in patients with EPS (P<0.001 and P=0.017 respectively). Patients with and without EPS were similar in terms of modality (P=0.21) but treatment duration with APD modality was longer in patients with EPS (P<0.001). The PD follow-up period was found to be a predictor of EPS formation (P<0.001, RR:1.034 [95% CI: 1.020-1.047]). Age (P<0.001, RR:1.039 (95% CI: 1.024-1.053) and use of hypertonic dialysis solution (P=0.007, RR:0.979 (95% CI: 0.965-0.994)) were the factors affecting survival in EPS patients.
EPS is a relatively rare but fatal complication of peritoneal dialysis and extension of PD duration is a risk for EPS formation. Younger age and usage of hypertonic dialysis solution affects mortality in patients with EPS.
包裹性腹膜硬化（EPS）是一种多因素导致的慢性腹腔内炎症性疾病，可弥漫性累及腹膜。本研究旨在评估我们腹膜透析（PD）人群中EPS的发生率，对临床表现进行全面评估，并确定受影响患者的结局及危险因素。
对2001年1月至2016年11月期间开始PD治疗的384例连续患者的病历进行评估。记录社会人口统计学特征、合并症、PD治疗细节及感染并发症。检查病历以确保病例符合ISPD关于EPS诊断的标准，包括临床特征及放射学和/或组织病理学确认。识别诊断为EPS的患者，并回顾患者的发病率、临床表现、治疗及近期状况。调查可能与EPS形成和死亡率相关的因素。
384例患者中201例为女性，平均年龄为45.9±15.6岁，平均PD随访时间为42.6±35个月。26例患者发生EPS，EPS发生率为6.7%。EPS患者的PD随访期和高渗溶液使用时间更长（分别为P<0.001和P=0.017）。有和无EPS的患者在透析方式方面相似（P=0.21），但EPS患者采用自动化腹膜透析（APD）方式的治疗时间更长（P<0.001）。发现PD随访期是EPS形成的一个预测因素（P<0.001，相对风险：1.034 [95%置信区间：1.020 - 1.047]）。年龄（P<0.001，相对风险：1.039 [95%置信区间：1.024 - 1.053]）和高渗透析液的使用（P=0.007，相对风险：0.979 [95%置信区间：0.965 - 0.994]）是影响EPS患者生存的因素。
EPS是腹膜透析一种相对罕见但致命的并发症，PD疗程延长是EPS形成的一个风险因素。较年轻的年龄和高渗透析液的使用影响EPS患者的死亡率。
