Length of Time on Peritoneal Dialysis and Encapsulating Peritoneal Sclerosis: Position Paper for Ispd

Abstract

eritoneal dialysis (PD) is a successful dialysis modal-ity that enables patients with end-stage kidneydisease to have a home-based treatment with many ad-vantages for their quality of life. In general, outcomes ofPD are equal to those of hemodialysis (HD). The reportedtechnique success of PD is, however, shorter than that ofHD. Whereas there are “positive” reasons for droppingout, such as transplantation or recovery of renal function,some patients transfer to HD because of peritonitis, in-adequate small solute clearance and/or ultrafiltration,and social factors (1). The impact of adequacy and prob-lems with maintaining euvolemia as reasons for dropoutincrease over time, especially as residual renal functiondeclines. Nevertheless, even anuric patients can be main-tained successfully on PD (2,3). Many patients are reluc-tant to transfer to HD, even when clinically indicated,because they perceive that such a transfer would ad-versely affect their quality of life. A proper presentationof different renal replacement therapies from the startof treatment onward (integrated care) could potentiallyavoid disappointment when a transfer is needed.One of the potential, although infrequent, complica-tions of long-term PD is encapsulating peritoneal scle-rosis (EPS); it is associated with high morbidity relatedto bowel obstruction and malnutrition. Reported mor-tality is around 50%, usually within 12 months of thediagnosis (4,5), although not all deaths are due to EPSitself (6). The first reports of EPS were from Japan andAustralia (4,7,8); more recently, there has been an in-creasing number of reports of EPS in Europe (9–11). Somenephrologists have suggested that there should be a timelimit to PD to prevent patients from developing this po-tentially devastating complication.The principal aims of this paper are1. To review existing information about epidemiologyof EPS and its risk factors;2. To determine whether there are any predictors forthe development of EPS that would guide the deci-sion to stop PD and transfer to HD; and3. To reach a consensus that should be given tonephrologists and their patients about the lengthof time it is advisable to remain on PD.GUIDELINES FOR EPSSo far, guidelines on the topic of EPS have been is-sued only by the Japanese Society for Peritoneal Dialy-sis (12). The UK guidelines are in the final process of