Peritoneal dialysis patients with high effluent fibrin degradation products.

Encapsulating peritoneal sclerosis (EPS) is a major and fatal complication of peritoneal dialysis (PD). For treatment, the efficacies of steroids, tamoxifen, immunosuppressants, and surgical total intestinal enterolysis have been reported, but the results have not been sufficient. Because treatment after the onset of EPS is limited, a prophylactic therapy is needed. We previously reported that the level of effluent fibrin degradation products (eFDPs) is predictive of EPS. In the present study, we investigated the clinical course of PD cases with high eFDP levels, and the effect of prophylactic steroid therapy against EPS. Between January 2002 and August 2008, we investigated 310 PD patients, of whom 22 had an eFDP level of 30 microg/mL or more in 4-hour effluent from a fast peritoneal equilibration test (PET). Mean patient age was 62.6 +/- 11.1 years, and mean duration of dialysis was 42.7 +/- 45.5 months (range: 1 - 202 months). During a fast PET performed every 6 months, we measured, in 4-hour effluent, eFDPs, cancer antigen 125 (eCA125), and dialysate-to-plasma creatinine (D/P Cr). In addition, we calculated D/P beta2-microglobulin (beta2MG) from levels in overnight dialysis effluent and blood. In the 22 cases, the mean eFDP level was 66.6 +/- 39.2 microg/mL; the D/P Cr 0.78 +/- 0.1; and the D/P beta2MG 0.45 +/- 0.2. Steroid (5 - 30 mg daily) was administered to 8 of the 22 patients. In the 8 treated cases, the eFDP level, the D/P Cr, and the D/P beta2MG declined, but did not return to normal, and EPS developed in 2 patients. The eFDP level was high when dialysis was introduced, but returned to normal in 2 of the remaining 14 patients. In 1 of the 14 cases, peritonitis developed 5 times, followed by rapid elevation in the eFDP level. The patient with this intractable peritonitis was switched to hemodialysis. The other 11 patients received no steroid therapy. In 1 of these 11 patients, the eFDP level declined, but not in the others. We suggest that active steroid therapy for patients with a high level of eFDPs may prevent EPS development.