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A broad consensus has not been reached on the appropriate timing for cessation of peritoneal dialysis (PD). Decreasing urine volume, repeated and refractory peritonitis, and deterioration of the peritoneal membrane are major reasons to stop PD. Also, the link between length of time on PD and encapsulating peritoneal sclerosis (EPS) should be an additional concern. The aim of the present study was to investigate patients who had been on continuous ambulatory PD (CAPD) for a long time. All patients undergoing CAPD at our kidney center for more than a decade from January 1990 to September 2011 were included in the study. Among more than 436 CAPD patients, 11 met the inclusion criteria. Their mean PD duration was 12.3 +/- 3.1 years. Mean age at CAPD introduction had been 46.0 +/- 10.1 years. All patients had nondiabetic nephropathy as the underlying cause of their end-stage renal disease. At least 2 of the 11 had developed EPS, and 1 had subsequently died from EPS. Patients on prolonged CAPD for more than a decade are still rare. The CAPD modality may be continued if it is efficiently maintained within an acceptable level, but EPS remains a serious complication of prolonged PD.

Peritonitis remains a leading complication of peritoneal dialysis (PD). The aim of this observational retrospective cohort study, conducted at our single center, was to determine the risk factors for peritonitis. A Cox proportional hazards model was used for the multivariate analysis. The event investigated was peritonitis, and the variables studied were sex, age, diabetes mellitus, use of statins, and several laboratory values including albumin and total cholesterol. All PD patients who visited our clinic from January 2005 to September 2011 and who had complete medical records for at least 3 years were included. Among the 82 patients who met the criteria (mean period of observation: 1086 +/- 752 days; mean age: 62.0 +/- 12.3 years), 47 had experienced at least 1 episode of peritonitis. Aging was a significant risk factor for peritonitis, with a relative risk of 1.04 per year (p = 0.014). In our study, aging--rather than diabetes mellitus, efficiency of PD, or nutrition status--was an important risk factor for PD-associated peritonitis. Poor PD technique because of advanced age might be one of the reasons for this result.

In the present study, we examined the risk factors and causes for removal of the peritoneal dialysis (PD) catheter in patients on continuous ambulatory PD (CAPD). Data were collected from the records of patients who received CAPD therapy from 1995 to 2007 in the Department of Nephrology, Saitama Medical University. During that time, 473 patients were introduced onto CAPD therapy and the PD catheter was removed from 63 patients. Catheters were removed in 30 patients (47%) because of peritoneal infection, in 11 (17%) because of dialysis failure, in 8 (13%) because of neoplasm of the gastrointestinal tract, in 6 (10%) because of perforation of the gastrointestinal tract, in 2 (3%) because of laceration of PD catheter, and in 3 each (5%) because of transplantation and home hemodialysis therapy. Duration of CAPD was 5.6 +/- 1.2 years. In patients who experienced peritoneal infection, causative organisms were Staphylococcus (mainly methicillin-resistant S. aureus), Candida, Pseudomonas, and non tuberculous Mycobacterium. Failure to continue PD therapy related to dialysis deficiency. All patients were examined for encapsulating peritoneal sclerosis (EPS) by computed tomography (CT) enhanced using contrast material. In 9 cases in which the CT findings indicated EPS, treatment with oral prednisolone (20 mg daily) was started; the dose was then gradually reduced over 1 year. After removal of the PD catheter, no patient developed EPS. All removed catheters were examined using electron microscopy. The catheters from patients who experienced PD peritonitis revealed biofilm formation; however, no biofilm formation was found in PD catheters removed from patients without infection. Despite appropriate antibiotic therapy, peritoneal infection remains the major cause of PD catheter removal. Biofilm formation might be an obstacle to PD continuation.

In the present study, we examined the association between vascular and valvular calcification and the prognosis of patients on continuous ambulatory peritoneal dialysis (CAPD). Data were collected from the records of patients introduced onto CAPD therapy during 1999 - 2006 at the Department of Nephrology, Saitama Medical University. At the start of CAPD, cardiac and vascular echography were used to examine 162 patients (average age: 56 +/- 5 years; 58 men, 104 women; 43 with and 119 without diabetes) for evaluation of vascular and valvular calcification. Both vascular and valvular calcification were found in 32 patients. Vascular calcification was found in 16, and valvular calcification in 11. Over 5 years, 11 patients suffered from cardiovascular disease (7 with stroke, 4 with myocardial infarction). All of these patients had vascular or valvular calcification at the start of CAPD therapy. We also used Cox hazard analysis to examine values for Ca, P, Ca x P, intact parathyroid hormone (iPTH), and lipids. None of these values were independent contributory factors for incidence of cardiovascular disease in patients on CAPD. These data suggest the importance of vascular and valvular echography to evaluate patients on CAPD, especially at the start of CAPD therapy. Vascular and valvular calcification are important factors for determining the prognosis of patients on CAPD.