Encapsulate Peritoneal Dialysis in Peritoneal Dialysis - short term post PD

Encapsulated Peritoneal Sclerosis (EPS) is a devastating complication of long term CAPD. The diagnosis is based on structural and functional aspects of intestinal obstruction. The total imaging score at the time of diagnosis of EPS did not correlate with the clinical outcome. It is important to differentiate simple peritoneal sclerosis from EPS.The incidence increases from zero to 18% with time on peritoneal dialysis for 5-8 years. The risk of EPS increases exponentially when PD continues beyond 3 years. The other potential risk factors are high strength glucose exposure, icodextrin, young age, inflammation, chemical exposure, genetic factors, acidic PD fluid. Peritoneal injury and subsequent peritoneal inflammation are two hit hypothesis for EPS. But episodes of peritonitis, intense or repeated hemoperitoneaum, abdominal surgery, stopped PD, and genetic predisposition could be the potential risk factors. There is no authentic screening tool for early diagnosis. The combination of Ca-125<33 U/min and IL-6> 350 pg/min with UFF suggest the possibility to identify patients at risk. High levels of cytokines in peritoneal effluent correlate with alteration peritoneal membrane transport status. The pathophysiology of EPS consists of inflammation, fibrin deposition and fibrinolysis, epithelial-mesenchymal transition, and growth factors. Ultrafiltration failure and high average transport status are very common in EPS. High awareness to detect the earliest stage of EPS might help to improve survival. Discontinuation of PD, nutritional support, immunosuppressive therapy, tamoxifen and surgery are medical options. There is no strategy to prevent EPS. In the case of PD catheter removal, dry peritoneum might lead to new fibrin deposition and accelerate sclerosing process. Periodic irrigation of peritoneal cavity for 6-12 months after cessation of PD therapy might prevent intestinal adhesion