SP514ENCAPSULATING PERITONEAL SCLEROSIS (EPS): A SERIOUS COMPLICATION ASSOCIATED WITH PERITONEAL DIALYSIS

Abstract

INTRODUCTION AND AIMS: Peritoneal sclerosis is a rare and serious complication associated with peritoneal dialysis (PD), with difficult management, high morbidity and mortality. Diagnosis is suspected when digestive symptoms (such as nausea, vomiting or weight loss) and bowel habit alterations are present. Confirmation requires thickening of peritoneal membrane and encapsulation with either an abdominal CT or peritoneal biopsy. Treatment is mainly symptomatic, including analgesia and nutritional support. Steroids and tamoxifen are used to prevent fibrosis. In advanced cases, surgery may be necessary. AIMS: To analyze the incidence and outcomes of EPS in our series. METHOD(S): A retrospective analysis of all patients starting on PD from 1999 until 2015 in a single PD unit was carried out. A deep review of the records of cases with EPS was performed. Studied variables included demographic data, risk factors, method of diagnosis, specific treatment and outcomes. RESULT(S): Of the 273 patients initiated on peritoneal dialysis during the study period 6 presented EPS (2.2%). Median age at PD onset 39 years (range 22 - 60). Three were females. EPS was diagnosed in 3 patients while they were on PD. In three cases EPS developed after transferring to another renal replacement therapy: 2 after kidney transplantation (KT) and 1 while on haemodialysis. Among the known risk factors for EPS development 5 patients had at least one previous episode of peritonitis. In 3 of them peritonitis was severe and in 2 cases associated haemoperitoneum. Five patients had previous abdominal surgery; one patient had systemic lupus erythematosus and another one endometriosis. Four patients received tacrolimus for KT. Coincidently with digestive symptoms inflammatory markers increased (C Reactive Protein 13-129 IU), whereas malnourishment became evident with low albumin levels (below 3.5 g/dl) detected in all patients. Only 50% presented leukocytosis. Abdominal CT was compatible with EPS diagnosis in all cases. Peritoneal biopsy was performed in 3 patients (50%) confirming EPS. Administration of tamoxifen (5 patients) was initiated as soon as EPS was suspected. Three patients received steroids (1mg/Kg/day) when diagnosis was established by CT and nutritional support whenever required due to weight loss and obstructive symptoms. Overall mortality was 50%. In the two KT patients with EPS, tamoxifen was started and calcineurin inhibitors switched to m-tor. Both are alive and well nourished, having spent more than 36 months after diagnosis. Both maintain good graft function with serum creatinine around 1.1 - 1.3 mg/dl. They did not require surgical intervention for EPS. CONCLUSION(S): Peritoneal sclerosis is a rare and severe complication associated with peritoneal dialysis requiring high clinical suspicion to diagnose it in early stages. Development of EPS in patients with a functioning KT is not unusual. Establishing a timely treatment with a multidisciplinary team improves prognosis and patient survival.