In recent years the fear of encapsulating peritoneal sclerosis (EPS) prompted some nephrologists to consider peritoneal dialysis a time-limited therapy. Such an expiry date is devoid of a rational basis because peritoneal dialysis is a mere risk factor for EPS, not an etiological cause. This disease is in fact triggered by a second stimulus different from peritoneal dialysis and often even consisting of its withdrawal. Epidemiological studies have confirmed that interrupting peritoneal dialysis at a fixed time not only is useless in preventing EPS but might be counterproductive. Moreover, the quality of life of the patient should also be taken into account. Evidence obtained in recent years strongly suggests the effectiveness of other approaches in the prevention of EPS: 1) routine use of biocompatible peritoneal dialysis solutions; 2) inhibition of the renin-angiotensin-aldosterone axis as an elective therapy for hypertension in peritoneal dialysis; 3) prophylaxis with low-dose tamoxifen (10 mg per day) in high-risk patients (peritoneal dialysis >5 years, development of ultrafiltration failure and/or transport alterations); 4) a specific immunosuppressive protocol for former peritoneal dialysis patients undergoing transplantation: a sirolimus- or everolimus-based regimen with mycophenolate, avoidance or at least minimization of cyclosporine and tacrolimus, and use of steroids in the first 6-12 months. All of us should seriously consider the efficacy of these approaches in controlled clinical trials.

Garosi, G. (2010). Dialisi peritoneale: metodica a termine a causa della peritonite sclerosante? No, ma ci sono approcci migliori. [Peritoneal dialysis: a time-limited therapy because of encapsulating peritoneal sclerosis? No, but better approaches are available]. GIORNALE ITALIANO DI NEFROLOGIA, 27(5), 456-463.

Dialisi peritoneale: metodica a termine a causa della peritonite sclerosante? No, ma ci sono approcci migliori. [Peritoneal dialysis: a time-limited therapy because of encapsulating peritoneal sclerosis? No, but better approaches are available]

Garosi, Guido
2010

Abstract

In recent years the fear of encapsulating peritoneal sclerosis (EPS) prompted some nephrologists to consider peritoneal dialysis a time-limited therapy. Such an expiry date is devoid of a rational basis because peritoneal dialysis is a mere risk factor for EPS, not an etiological cause. This disease is in fact triggered by a second stimulus different from peritoneal dialysis and often even consisting of its withdrawal. Epidemiological studies have confirmed that interrupting peritoneal dialysis at a fixed time not only is useless in preventing EPS but might be counterproductive. Moreover, the quality of life of the patient should also be taken into account. Evidence obtained in recent years strongly suggests the effectiveness of other approaches in the prevention of EPS: 1) routine use of biocompatible peritoneal dialysis solutions; 2) inhibition of the renin-angiotensin-aldosterone axis as an elective therapy for hypertension in peritoneal dialysis; 3) prophylaxis with low-dose tamoxifen (10 mg per day) in high-risk patients (peritoneal dialysis >5 years, development of ultrafiltration failure and/or transport alterations); 4) a specific immunosuppressive protocol for former peritoneal dialysis patients undergoing transplantation: a sirolimus- or everolimus-based regimen with mycophenolate, avoidance or at least minimization of cyclosporine and tacrolimus, and use of steroids in the first 6-12 months. All of us should seriously consider the efficacy of these approaches in controlled clinical trials.
Garosi, G. (2010). Dialisi peritoneale: metodica a termine a causa della peritonite sclerosante? No, ma ci sono approcci migliori. [Peritoneal dialysis: a time-limited therapy because of encapsulating peritoneal sclerosis? No, but better approaches are available]. GIORNALE ITALIANO DI NEFROLOGIA, 27(5), 456-463.
File in questo prodotto:
File Dimensione Formato  
GItalNefrol2010.pdf

non disponibili

Descrizione: Articolo
Tipologia: PDF editoriale
Licenza: NON PUBBLICO - Accesso privato/ristretto
Dimensione 130.72 kB
Formato Adobe PDF
130.72 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11365/1215897