#4383 WHEN SHOULD WE TRY TREATMENT FOR PERITONEAL SCLEROSIS?

Abstract

Abstract Background and Aims Although it is very important to detect patients at increased risk of developing encapsulating peritonitis (EPS), there are not established predictors which would promote early diagnosis and treatment of EPS ensuring sustainability of peritoneal dialysis (PD). D-Dimers are considered a significant test in evaluation of peritoneal fibrinolysis activity and Ca 125 is used as an alternative marker for the integrity of peritoneal membrane.[1] We examined prospectively a combination of these surrogate markers both in serum and effluent to discern early peritoneal sclerosis. Method In a cohort of 39 PD patients D-Dimers, Ca 125, CRP along with a complete biochemical profile were tested both in serum and overnight effluent dialysate at the beginning of the study. In 9 patients, who presented with recurrent gastrointestinal symptoms, such as mild nausea, incidence of gastric discomfort or sense of bloating, CT imaging was performed for evaluation of potent EPS and thickening of the bowel wall was measured. The latter group of nine patients received tamoxifene for a period of approximately one year and both serum/effluent biomarkers and CT imaging were repeated at the end of this period. Results In Table 1 characteristics of patients are shown. At the beginning of the study CRP was the only biomarker that was different between the group with or without gastrointestinal symptoms (4±6mg/dl vs 0.8±1.1mg/dl, p = 0.04). In patients, who received tamoxifene gastrointestinal symptoms improved. In these patients follow up with CT imaging demonstrated amelioration of bowel wall thickening compared to the beginning (3±1.2mm vs 2.1±0.4mm), which was not statistically significant. Moreover, Ca 125 in dialysate decreased (60.4±74 U/ml vs 27±27 U/ml, p = 0.04). No side effects were recorded. Five patients are still on PD, 3 patients died from unrelated causes and 1 was transferred to hemodialysis. Conclusion In this study neither D-Dimers, a test for the assessment of the peritoneal fibrinolysis activity, nor Ca 125 an alternative marker for assessing the integrity of peritoneal membrane helped us to distinguish patients at risk for EPS. In fact Ca 125 levels in the effluent were higher in the treated group just before initiation of treatment, although in some references it is proposed that it is minimized.[1,2] Clinical evaluation along with radiologic findings led us to the decision to treat patients with tamoxifene, which exerts a protective effect on the peritoneal membrane during both early and late stages of fibrotic disorders.[3] Despite the small number of patients in this study, bowel wall thickening showed a tendency to decrease and symptoms improved.