PERITONEAL SCLEROSIS IN CHRONIC PERITONEAL-DIALYSIS PATIENTS - ANALYSIS OF CLINICAL PRESENTATION, RISK-FACTORS, AND PERITONEAL TRANSPORT KINETICS

Objective: To analyze clinical features of peritoneal sclerosis (PS) i n a group of peritoneal dialysis (PD) patients, and to compare potenti al risk factors and peritoneal transport characteristics with a contro l group matched for duration of PD. Design: Study 1 : Retrospective st udy of 16 PD patients with PS. Study 2: Case-control study comparing 1 0 patients with evident PS to 30 control patients who were matched for duration of PD. Setting: Continuous Ambulatory Peritoneal Dialysis un it in the Academic Medical Centre in Amsterdam. Results: The incidence of PS was 3.5 per 1000 patient years. PS was diagnosed either during PD (n = 10), in patients on hemodialysis (n = 2), or after successful transplantation (n = 4). Presenting symptoms were bowel obstruction, a scites, blood-stained effluent, and impaired net ultrafiltration. Macr oscopic confirmation of the diagnosis was possible in 13 patients. Scl erotic encapsulation was present in 8 of them. Patients with PS were d ivided into three groups based on clinical symptoms and typical macros copical findings. In category I the diagnosis PS was obvious (10 patie nts), in category II the diagnosis was highly suggestive (3 patients), and in category III it was doubtful (3 patients). Treatment was conse rvative in most patients. Surgical treatment was only possible in four and immunosuppressive therapy was given in 5 patients. Peritoneal scl erosis was the direct cause of death in 1 patient. Five patients died during follow-up due to other causes. At present, 7 patients are well and 3 patients (all from category I) still have recurrent bowel obstru ction. Compared to matched controls, no difference existed in peritoni tis incidence, or in the percentage of patients with former renal tran splantations. The number of patients treated with beta-blocking agents and the number of previous abdominal surgeries were not different. Th e number of catheter-related surgical procedures was higher in the PS patients than in the control group. The mass transfer area coefficient (MTAC) of creatinine was higher in PS patients and net ultrafiltratio n with 1.36% glucose was lower. The estimated cumulative glucose expos ure until the diagnosis of PS was made was larger in PS patients than in their controls. This difference was already present in the first ye ar of Po treatment in 8 of 10 patients. The initial values for the MTA C creatinine were similar In both groups. Conclusions: The presenting symptoms of PS were bowel obstruction, ascites, and blood-stained effl uent, often in combination with loss of net ultrafiltration. Peritonea l sclerosis is a complication of long-duration PD and could also becom e manifest after a successful renal transplant. Treatment should be co nservative unless complications require surgical intervention. Patient s with PS had lower net ultrafiltration and higher transport rates com pared to controls who were matched for duration of PD. Although perito nitis incidence was similar, a relation of PS with severe peritonitis may be present in some patients. Glucose exposure is likely to be an i mportant risk factor for PS.