Long-term peritoneal dialysis is a risk factor of sclerosing encapsulatingperitonitis for children

Objective: Sclerosing encapsulating peritonitis (SEP) is a clinical syndrom e with a high mortality rate and is a serious complication of peritoneal di alysis (PD). Peritoneal sclerosis (PS) is a histological diagnosis. PS is u sually observed in the peritoneal specimens of patients with SEP. Avoiding SEP is considered to be extremely important for pediatric patients who may require long-term PD. In this study, the characteristics of patients with P S were investigated to determine when to perform peritoneal biopsies and ho w long PD can be performed safely. Design: A retrospective single-center study. Setting:Tokyo Metropolitan Kiyose Children's Hospital. Patients: A total of 109 children younger than 16 years have received chron ic PD in our unit since 1981. Among these children, 16 patients had been on PD for more than 5 years (mean 7.4 +/- 2.5 years) from May 1992 to March 1 999. Peritoneal biopsies were performed in 14 of the 16 patients, who were divided into two groups based on the histological diagnoses: a PS and a per itoneal fibrosis (PF) group. Results: The 14 patients were on PD for a mean of 7.8 +/- 2.5 years. There were 8 patients with PS and 6 patients with PF. SEP was observed in 2 patie nts in the PS group. The risk of PS increased with the duration of PD: 57% (8/14) > 5 years, 80% (4/5) > 8 years, and 100% (3/3) > 19 years. All patie nts in the PS group showed both peritoneal calcifications on abdominal CT s can and poor ultrafiltration at the time of diagnoses. Conclusion: Long-term PD was the important risk factor of SEP. If both peri toneal calcification on abdominal CT scan and poor ultrafiltration are obse rved in a patient on PD more than 5 years, a peritoneal biopsy should be pe rformed. If PS is detected, PD should be discontinued.