Abstract
We performed a cohort study evaluating the incidence and the risk factors for encapsulating peritoneal sclerosis (EPS) and pre-EPS findings in 240 patients who received peritoneal lavage after peritoneal dialysis (PD) withdrawal. EPS or bowel obstruction was assessed as the primary outcome, and ascites or an elevated CRP (pre-EPS findings) was assessed as a secondary outcome. The duration of PD, D/P-Cr, mesothelial cell area just before PD withdrawal (PD area), mesothelial cell area just before lavage withdrawal (lavage area) and the PD solution used for peritoneal lavage were investigated as possible risk factors for outcomes. The primary outcome was observed in 13 patients (5.4%), while a secondary outcome was observed in 42 patients (17.5%). Significant risk factors were PD duration and PD and lavage areas. Cutoff values, determined based on the sensitivity and specificity of the measures, were a PD area of 350 μm2 for the primary and secondary outcomes, a lavage area of 320 μm2 for the primary outcome, a lavage area of 300 μm2 for the secondary outcome, a PD duration of 120 months for the primary outcome, and a PD duration of 96 months for the secondary outcome. The cumulative incidence rate for the primary outcome was 4.2% after 1 and 2 years in the good prognosis group (lavage area <320 μm2 and a PD duration<120 months) and 39.7% after 1 and 2 years in the poor prognosis group (lavage area≥320 μm2 and a PD duration≥120 months) (p=0.0138). The cumulative incidence rate for the secondary outcome was 5.3% after 1 and 2 years in the good prognosis group (lavage area<300 μm2 and a PD duration<96 months) and 55.5% after 1 year and 70.3% after 2 years in the poor prognosis group (lavage area≥300 μm2 and a PD duration≥96 months) (p=0.0013). The lavage area decreased significantly after 3 months in the primary group and 9 to 15 months in the secondary group. The lavage area also decreased after 3 to 21 months in non-outcome patients with more than 350 μm2 of PD area, while in non-outcome patients with under 350 μm2 of PD area, the lavage area did not changed during 27 months post withdrawal observation. After the withdrawal of peritoneal lavage, EPS occurred in 3 of 104 patients and ascites occurred in 4. We concluded that risk factors for EPS and pre-EPS findings were the PD duration and the PD and lavage areas. EPS and pre-EPS findings developed during peritoneal lavage. However, effective prevention can be achieved by considering risk factors when performing peritoneal lavage after PD withdrawal.
