Sclerosing encapsulating peritonitis (SEP) is a rare but serious complication in patients with continuous ambulatory peritoneal dialysis (CAPD), and is characterized by a progressive, intra-abdominal, inflammatory process resulting in the formation of sheets of new fibrous tissue, which cover, bind, and constrict the viscera, thereby compromising the motility of the bowel. No satisfactory estimate is available on the comparative incidence of dialysis related SEP and the pathogenesis of SEP still remains uncertain. Although recent therapeutic approaches have reported varying degrees of success, an efficient measure to detect, at an early stage, patients at risk for SEP would be beneficial and a standardized treatment regimen to prevent the illness is urgently needed. This study aimed to evaluate the clinical features of SEP and to identify the possible risk factors for the development of SEP in CAPD patients. We retrospectively reviewed by questionnaire SEP cases among CAPD patients from 7 university hospital dialysis centers in Korea, including Yonsei University, Ajou University, Catholic University, Inha University, Kyungpook University, Seoul National University and Soonchunhyang University, from January 1981 to December 2002. Out of a total of 4, 290 CAPD patients in these centers, 34 cases developed SEP with an overall prevalence of 0.79%. The male to female ratio was 17: 17. The median age of these patients was 44.5 years (range 19 - 66). The median duration of CAPD before SEP was 64 months (9 - 144) and 68% of patients (23/34) had been on CAPD for more than 4 years. Peritonitis (including two fungal cases) was the main cause of catheter removal in SEP (27 cases, 79%). Seventy-five percent of the cases (15/ 20) were administered beta-blocker for a mean duration of 85 months (26 - 130). Among 10 cases with available peritoneal equilibration test (PET) data, 8 showed high transporter characteristics, and the remaining 2 were high average. Eighteen cases were diagnosed by clinical and radiologic methods, and 16 were surgically diagnosed. Eleven cases were surgically treated and the others were treated conservatively with intermittent total parenteral nutrition (TPN). The overall mortality rate was 24%. SEP is a serious, life threatening complication of CAPD. Most cases had a PD duration of more than 4 years, a history of severe peritonitis, and high transporter characteristics in PET. Therefore, to reduce the incidence of SEP, careful monitoring and treatment, including early catheter removal in patients with severe peritonitis, should be considered for long-term CAPD patients with the above characteristics.
Adult ; Aged ; Female ; Humans ; Incidence ; Korea/epidemiology ; Male ; Middle Aged ; Peritoneal Dialysis, Continuous Ambulatory/*adverse effects/*statistics & numerical data ; Peritonitis/*epidemiology/etiology/*pathology ; Prevalence ; Sclerosis

BACKGROUNDThe maximal use of the limited resource to improve peritoneal dialysis (PD) penetration and clinical outcomes is a challenge for all PD centers. In this study, we reported the experience and outcomes in successfully managing a rapidly growing PD center in Southern China.

METHODSA standard PD program with a team consisted of 6 nephrologists (3 doctors were in charge of catheter insertion and in-patients care, the other 3 doctors focused on PD patients' follow-up and education) and 11 nurses in a PD center at Sun Yat-sen University was established for PD patients follow-up in 2005. A prospective and observational study was conducted in all patients undergoing continuous ambulatory PD (CAPD) at our center from January 1, 2006 to December 31, 2009.

RESULTSThe yearly number of prevalent CAPD patients was 297, 409, 547 and 695 in 2006, 2007, 2008 and 2009, respectively. The PD catheter insertion was performed by the nephrologists with open surgical procedure and 94% of catheters were patent at one year. In 841 incident CAPD patients, the survival rates at the end of 1, 2, 3 and 4 years were 94%, 87%, 83% and 76%, respectively, while cumulative technique survival rates (death-censored) were 98%, 95%, 91% and 90%, respectively. Peritonitis rate was 1/68.5 patient months.

CONCLUSIONSBetter patient and technical survival rates as well as lower peritonitis episode have been achieved in our rapidly growing PD center. A standardized PD program, well-trained team members of PD doctors and nurses, and continuous quality improvement of PD are important elements in managing a successful PD program.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; China ; Female ; Humans ; Male ; Middle Aged ; Peritoneal Dialysis, Continuous Ambulatory ; statistics & numerical data ; Survival Rate ; Young Adult

OBJECTIVETo investigate the epidemiology, peritoneal dialysis (PD) related complications and survival outcomes of 236 patients with end-stage renal disease (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD) in our center from January, 2004 to November, 2009.

METHODSThe data including patient gender, age, time of PD initiation, addresses, types of medical reimbursement, primary diseases, modes of PD catheter placement surgery, types of PD catheter, PD-related complications, and time of drop out were retrospectively analyzed. PD catheter migration rate, peritonitis rate, drop out rate (DOR), length of the time of PD therapy (TOT), and survival rate were calculated and compared with those of patients in other PD centers.

RESULTSThe number of newly introduced patients increased gradually in the years from 2004 to 2009. The mean age of newly introduced patients was 47-/+16 years, and patients with age below 60 years accounted for 77.96%. Patients who paid for their own expenses accounted for 67.37% of all, and the rate of these patients decreased gradually. Similar to that in Asian-Pacific region, chronic glomerulonephritis was the most frequent cause of ESRD followed by diabetic nephropathy. The number of patients with chronic glomerulonephritis or obstructive nephropathy as the primary diseases was greater in this center than that reported in the Asian-Pacific region, accounting for 54.66% and 11.02% of all patients, respectively. In contrast, the patients with diabetic nephropathy or benign arteriolar renal sclerosis were less, accounting for 12.29% and 10.17% of all, respectively. PD catheter migration rate (8.05%) and peritonitis rate (1:44.22 patient-months) were both lower than those reported. The patient survival rates at 1, 2, 3 years were 83.65%, 51.59% and 29.81%, respectively, lower than those of other centers in the developed countries but higher than the mean levels in China. DOR decreased gradually to 11.56% in 2009, and TOT increased to 23.61 months.

CONCLUSIONThe above characteristics of the patients are related to many factors, including the "PD first" principle, high prevalence of urinary calculosis in the primary source regions of most patients, preventive partial omentum resection in some patients, education and follow-up for patients, and increased expense cover by medical insurance.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Glomerulonephritis ; complications ; Humans ; Kidney Failure, Chronic ; etiology ; therapy ; Male ; Middle Aged ; Peritoneal Dialysis, Continuous Ambulatory ; adverse effects ; statistics & numerical data ; Retrospective Studies ; Survival Rate ; Young Adult

This study examined intima-media thickness and arterial plaque occurrence in the carotid and brachial arteries in continuous ambulatory peritoneal dialysis (CAPD) patients. The study compared 25 CAPD patients with 25 normotensive age- and sex-matched controls. Intima-media thickness and presence of plaque in carotid and brachial artery were measured three times using high-resolution B-mode echocardiography. Left ventricular mass was calculated using the Penn Convection equation. Blood samples were obtained to assess levels of phosphorus, total calcium, serum albumin, C-reactive protein, and lipid profiles. Compared to the control group, CAPD patients had greater mean carotid and brachial intima-media thickness, and a higher proportion of subjects with calcified plaques. The left ventricular mass index was higher in CAPD patients with carotid artery calcified plaques compared to CAPD patients without carotid artery calcified plaques. CAPD patients with such plaque were significantly associated with diabetes mellitus, higher C-reactive protein levels and a lower 2-yr survival rate. The present study showed an high prevalence of carotid calcification in CAPD patients and those with such calcification had a greater incidence of diabetes mellitus, higher C-reactive protein levels and left ventricular mass index, and a lower survival rate.
Calcinosis/*mortality ; Carotid Stenosis/*mortality ; Comorbidity ; Female ; Humans ; Hypertrophy, Left Ventricular/*mortality ; Korea/epidemiology ; Male ; Middle Aged ; Peritoneal Dialysis, Continuous Ambulatory/*statistics and numerical data ; Prevalence ; Prognosis ; Research Support, Non-U.S. Gov't ; Risk Assessment/*methods ; Risk Factors ; Severity of Illness Index ; Statistics ; Survival Analysis ; Survival Rate