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Renal hyperparathyroidism- a risk factor in the development of encapsulating peritoneal sclerosis.
Moinuddin, Zia; Wang, Kelvin; Fullwood, Catherine; Wiredu, Elizabeth; Hutchison, Alastair; Vardhan, Anand; Herrick, Sarah E; Summers, Angela; Augustine, Titus; van Dellen, David.
Affiliation
  • Moinuddin Z; Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary (National Commissioning Group (NCG) funded United Kingdom Referral Centre for EPS Surgery), Manchester, United Kingdom.
  • Wang K; School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
  • Fullwood C; Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary (National Commissioning Group (NCG) funded United Kingdom Referral Centre for EPS Surgery), Manchester, United Kingdom.
  • Wiredu E; School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
  • Hutchison A; Department of Statistics, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
  • Vardhan A; Centre for Biostatistics, University of Manchester, Manchester, United Kingdom.
  • Herrick SE; Medical Statistics, Data Solution Services, Liverpool, United Kingdom.
  • Summers A; Department of Nephrology, Manchester Royal Infirmary, Manchester, United Kingdom.
  • Augustine T; Department of Nephrology, Manchester Royal Infirmary, Manchester, United Kingdom.
  • van Dellen D; School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
Front Endocrinol (Lausanne) ; 15: 1282925, 2024.
Article in En | MEDLINE | ID: mdl-38567303
ABSTRACT

Background:

Encapsulating peritoneal sclerosis (EPS) is a rare complication of prolonged peritoneal dialysis (PD) exposure, characterised by peritoneal thickening, calcification, and fibrosis ultimately presenting with life-threatening bowel obstruction. The presence or role of peritoneal calcification in the pathogenesis of EPS is poorly characterised. We hypothesise that significantly aberrant bone mineral metabolism in patients on PD can cause peritoneal calcification which may trigger the development of EPS. We compared the temporal evolution of bone mineral markers during PD in EPS patients with non-EPS long-term PD controls.

Methods:

Linear mixed model and logistic regression analysis were used to compare four-monthly serum levels of calcium, phosphate, parathyroid hormone, and alkaline phosphatase (ALP) over the duration of PD exposure in 46 EPS and 46 controls (PD, non-EPS) patients.

Results:

EPS patients had higher mean calcium (2.51 vs. 2.41 mmol/L) and ALP (248.00 vs. 111.13 IU/L) levels compared with controls (p=0.01 and p<0.001 respectively, maximum likelihood estimation). Logistic regression analysis demonstrated that high serum calcium and phosphate levels during PD were associated with a 4.5 and 2.9 fold increase in the risk of developing EPS respectively.

Conclusion:

High levels of calcium and phosphate in patients on PD were identified to be risk factors for EPS development. Possible reasons for this may be an imbalance of pro-calcifying factors and calcification inhibitors promoting peritoneal calcification which increases peritoneal stiffness. Mechanical alterations may trigger, unregulated fibrosis and subsequent development of EPS. Improved management of secondary hyperparathyroidism during PD may ultimately diminish the EPS risk.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Calcinosis / Peritoneal Fibrosis / Hyperparathyroidism Limits: Humans Language: En Journal: Front Endocrinol (Lausanne) Year: 2024 Document type: Article Affiliation country: United kingdom

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Calcinosis / Peritoneal Fibrosis / Hyperparathyroidism Limits: Humans Language: En Journal: Front Endocrinol (Lausanne) Year: 2024 Document type: Article Affiliation country: United kingdom