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Peritoneal inflammation precedes encapsulating peritoneal sclerosis: results from the GLOBAL Fluid Study

Lambie, Mark R.; Chess, James; Summers, Angela M.; Ford Williams, Paul; Topley, Nicholas; Davies, Simon J.; Study Investigators, GLOBAL Fluid; Smith, Anna-Clare; Craig, Kathryn; Fallon, Maureen; James, Charlotte; Huxtable, Hilary; Gilbert, Gill; Jones, Catherine; Capper, Helen


James Chess

Angela M. Summers

Paul Ford Williams

Nicholas Topley

GLOBAL Fluid Study Investigators

Anna-Clare Smith

Kathryn Craig

Maureen Fallon

Charlotte James

Hilary Huxtable

Gill Gilbert

Catherine Jones

Helen Capper


BACKGROUND: Encapsulating peritoneal sclerosis (EPS) is an uncommon condition, strongly associated with a long duration of peritoneal dialysis (PD), which is itself associated with increased fibrosis in the peritoneal membrane. The peritoneal membrane is inflamed during PD and inflammation is often associated with fibrosis. We hypothesized that patients who subsequently develop EPS might have a more inflamed peritoneal membrane during PD. METHODS: We performed a nested, case-control study identifying all EPS cases in the UK arm of the GLOBAL Fluid Study and matching them by centre and duration of PD with two to three controls. Dialysate and plasma samples were taken during repeated peritoneal equilibration tests prior to cessation of PD from cases and controls. Samples were assayed by electrochemiluminescence immunoassay for interleukin-1ß (IL-1ß), tumour necrosis factor a (TNF-a), interferon-? (IFN-?) and IL-6. Results were analysed by linear mixed models adjusted for age and time on PD. RESULTS: Eleven EPS cases were matched with 26 controls. Dialysate TNF-a {0.64 [95% confidence interval (CI) 0.23, 1.05]} and IL-6 [0.79 (95% CI 0.03, 1.56)] were significantly higher in EPS cases, while IL-1ß [1.06 (95% CI -0.11, 2.23)] and IFN-? [0.62 (95% CI -0.06, 1.29)] showed a similar trend. Only IL-6 was significantly higher in the plasma [0.42 (95% CI 0.07, 0.78)]. Solute transport was not significantly different between cases and controls but did increase in both groups with the duration of PD. CONCLUSIONS: The peritoneal cavity has higher levels of inflammatory cytokines during PD in patients who subsequently develop EPS, but neither inflammatory cytokines nor peritoneal solute transport clearly discriminates EPS cases. Increased systemic inflammation is also evident and is probably driven by increased peritoneal inflammation.


Lambie, M. R., Chess, J., Summers, A. M., Ford Williams, P., Topley, N., Davies, S. J., …Capper, H. (2016). Peritoneal inflammation precedes encapsulating peritoneal sclerosis: results from the GLOBAL Fluid Study. Nephrology Dialysis Transplantation, 31(3), 480 -486.

Journal Article Type Article
Acceptance Date Dec 1, 2015
Publication Date Mar 1, 2016
Journal Nephrology Dialysis Transplantation
Print ISSN 0931-0509
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 31
Issue 3
Pages 480 -486
Keywords Body Fluids, chronic inflammation, Cytokines, Dialysis Solutions, encapsulating peritoneal sclerosis, Female, Follow-Up Studies, GLOBAL Fluid Study Investigators, Humans, Male, Middle Aged, peritoneal dialysis, Peritoneal Dialysis, Peritoneal Fibrosis, pe
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