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Is There an End in Sight for Encapsulating Peritoneal Sclerosis?

Encapsulating peritoneal sclerosis (EPS) was first described by Gandhi et al. (1). Encapsulating peritoneal sclerosis carries high morbidity and morbidity due to abdominal pain and nutritional problems. The mortality from this condition has been estimated to be 50%, although better results have been recently reported from tertiary surgical centers (2). Epidemiological studies have been derived from various registries such as Scottish, Pan-Thames (south-east England), Netherlands, Australia-New Zealand, and Japan (3–6). There is consensus that EPS is very rare in people who were on peritoneal dialysis (PD) for less than 3 – 4 years. For those with PD exposure below 1 year, the incidence approaches 0, and for those below 3 years, it is less than 1%. However, the percentage steadily rises as the duration of PD goes beyond 3 – 5 years (8% being at the high end; Scottish Registry (4)). There is the golden truth that prevention is better than cure. To “prevent” this disease, should we limit PD exposure to our patients (e.g. to 5 years)? This question was addressed in a Position Statement by the International Society of PD (ISPD) (7) and concludes that there is not enough evidence to withhold PD because of the fear of EPS, nor should there be a single rule about optimal length of time on PD to avoid the risk of EPS. The subtext of the ISPD position statement is: