Outcome of Sclerosing Peritonitis Complicating Peritoneal Dialysis

Abstract

Sclerosing peritonitis (SP) is a rare but serious complication of peritoneal dialysis. Multiple causes have been implicated in its pathogenesis. Different approaches to management include conservative treatment, surgical intervention, and immunosuppressive therapy. We retrospectively reviewed the presentation and treatment outcome of seven patients with SP. Overall, 552 patients underwent continuous ambulatory peritoneal dialysis (CAPD) between 1994 and 2003. Patients were included if there were suggestive clinical features and either radiologic or surgical evidence of SP. Seven patients developed SP, five men and two women, with a median age of 41 years (range, 32-64 years). The median duration of CAPD prior to development of SP was 72 months (range, 48-125 months). In six patients, SP occurred soon after an episode of CAPD-related peritonitis (range, 1-7 months). Patients presented with acute abdominal pain, ascites, small bowel intestinal obstruction, and failure of Tenckhoff catheter reinsertion. Abdominal X-ray, ultrasonography, and computed tomography scans were helpful in the diagnosis. Laparotomies were performed in six patients (typical cocoon appearance of peritoneum in three). No patients underwent adhesiolysis or received immunosuppressive therapy. All patients were switched to hemodialysis. Five patients required temporary total parenteral nutritional support. Four patients survived but none returned to CAPD. The other three patients died of sepsis. SP is a serious complication of peritoneal dialysis with a mortality rate of 43%. Severe peritonitis, especially in patients on dialysis for longer than 4 years, is associated with development of SP. Prevention and optimal treatment of CAPD-related peritonitis might be important in preventing SP.