Vincenzo La Milia1, Selena Longhi2,3, Elisabetta Sironi2,3, Giuseppe Pontoriero2. 1. Department of Nephrology and Dialysis, A. Manzoni Hospital, Via dell'Eremo 9/11, 23900, Lecco, Italy. v.lamilia@asst-lecco.it. 2. Department of Nephrology and Dialysis, A. Manzoni Hospital, Via dell'Eremo 9/11, 23900, Lecco, Italy. 3. Department of Health Sciences, University of Milan-Bicocca, Milan, Italy.
Abstract
BACKGROUND AND AIMS: Encapsulating peritoneal sclerosis (EPS) is an uncommon but severe complication of peritoneal dialysis (PD). A reliable screening tool to identify patients at risk of developing or not EPS is currently not available. We aimed to evaluate whether the reduction in dialysate sodium concentration (sodium sieving) at 60 min (ΔDNa60), during a peritoneal equilibration test with 3.86% glucose concentration (3.86%-PET) was able to early rule out patients who will not develop EPS. METHODS: Prospective controlled longitudinal (20-year) cohort study. All eligible incident PD patients attending the hospital underwent a 3.86%-PET during the first 3 months following start of PD and then once a year. The dip in ΔDNa60 and other factors were correlated with eventual EPS onset. RESULTS: Of 161 incident PD patients, with a median PD duration of 37.8 (24.7-58.3) months and 64.1 (34.5-108.3) months of follow-up, 13 patients (8%) developed EPS at a median PD duration of 72.7 (56.6-109.4) months and 105.0 (76.4-143.2) months of follow-up. ΔDNa60 demonstrated the best sensitivity and specificity values, estimated by conventional receiver operating characteristic (ROC) curve analysis with an area under the curve (AUC) of 0.90, 0.83 and 0.85 at 1, 2 and 3 years before the onset of EPS, respectively. Multifactorial analysis showed that the most useful factors for predicting EPS were age at start of PD, duration of PD, small solutes transport (D/PCreat) and ΔDNa60; the AUC at 1, 2 and 3 years before the onset of EPS was, respectively, 0.97, 0.96 and 0.94, the positive predictive value being 0.48, 0.57 and 0.42, and the negative predictive value 1.0, 1.0 and 1.0. CONCLUSIONS: It is possible to predict the occurrence and, better, the non-occurrence of EPS using simple parameters such as age at PD start, duration of PD, and parameters obtained by 3.86%-PET such as D/PCreat and ΔDNa60.
BACKGROUND AND AIMS: Encapsulating peritoneal sclerosis (EPS) is an uncommon but severe complication of peritoneal dialysis (PD). A reliable screening tool to identify patients at risk of developing or not EPS is currently not available. We aimed to evaluate whether the reduction in dialysate sodium concentration (sodium sieving) at 60 min (ΔDNa60), during a peritoneal equilibration test with 3.86% glucose concentration (3.86%-PET) was able to early rule out patients who will not develop EPS. METHODS: Prospective controlled longitudinal (20-year) cohort study. All eligible incident PDpatients attending the hospital underwent a 3.86%-PET during the first 3 months following start of PD and then once a year. The dip in ΔDNa60 and other factors were correlated with eventual EPS onset. RESULTS: Of 161 incident PDpatients, with a median PD duration of 37.8 (24.7-58.3) months and 64.1 (34.5-108.3) months of follow-up, 13 patients (8%) developed EPS at a median PD duration of 72.7 (56.6-109.4) months and 105.0 (76.4-143.2) months of follow-up. ΔDNa60 demonstrated the best sensitivity and specificity values, estimated by conventional receiver operating characteristic (ROC) curve analysis with an area under the curve (AUC) of 0.90, 0.83 and 0.85 at 1, 2 and 3 years before the onset of EPS, respectively. Multifactorial analysis showed that the most useful factors for predicting EPS were age at start of PD, duration of PD, small solutes transport (D/PCreat) and ΔDNa60; the AUC at 1, 2 and 3 years before the onset of EPS was, respectively, 0.97, 0.96 and 0.94, the positive predictive value being 0.48, 0.57 and 0.42, and the negative predictive value 1.0, 1.0 and 1.0. CONCLUSIONS: It is possible to predict the occurrence and, better, the non-occurrence of EPS using simple parameters such as age at PD start, duration of PD, and parameters obtained by 3.86%-PET such as D/PCreat and ΔDNa60.
Authors: Edwina A Brown; Wim Van Biesen; Fredric O Finkelstein; Helen Hurst; David W Johnson; Hideki Kawanishi; Roberto Pecoits-Filho; Graham Woodrow Journal: Perit Dial Int Date: 2009 Nov-Dec Impact factor: 1.756
Authors: Joerg Latus; Christoph Ulmer; Peter Fritz; Bianka Rettenmaier; Dagmar Biegger; Thomas Lang; German Ott; Christoph Scharpf; Martin Kimmel; Wolfgang Steurer; M Dominik Alscher; Niko Braun Journal: Nephrol Dial Transplant Date: 2012-06-25 Impact factor: 5.992
Authors: David W Johnson; Yeoungjee Cho; Brian E R Livingston; Carmel M Hawley; Stephen P McDonald; Fiona G Brown; Johan B Rosman; Kym M Bannister; Kathryn J Wiggins Journal: Kidney Int Date: 2010-03-10 Impact factor: 10.612
Authors: Denise E Sampimon; Mario R Korte; Deirisa Lopes Barreto; Anniek Vlijm; Rudy de Waart; Dirk G Struijk; Raymond T Krediet Journal: Perit Dial Int Date: 2010-02-01 Impact factor: 1.756
Authors: Ruth M Tarzi; Adrian Lim; Steven Moser; Sohail Ahmad; Abraham George; Gowrie Balasubramaniam; Elaine J Clutterbuck; Wladyslaw Gedroyc; Edwina A Brown Journal: Clin J Am Soc Nephrol Date: 2008-07-30 Impact factor: 8.237