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Nutritional management of patients undergoing surgery following diagnosis with encapsulating peritoneal sclerosis.

AbstractBACKGROUND:
Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of peritoneal dialysis (PD). Gastrointestinal (GI) symptoms affect appetite and dietary intake. Adequate nutrition is especially important if surgical interventions are required.
AIM:
To investigate the nutritional management of 23 EPS patients that underwent surgical intervention between 1999 and 2005 at Manchester Royal Infirmary, United Kingdom.
METHODS:
EPS was recognized by GI symptoms and diagnostically confirmed by laparotomy, computed tomographic scanning, or biopsy.
RESULTS:
Mean time on PD was 74 months (interquartile range 42-89 months). During the 12 months pre-diagnosis, 65% of the group showed significant weight loss (p = 0.0001), with 8 patients losing >10% of body weight; 74% of patients experienced significant albumin decrease (p = 0.001); and 56% of patients experienced GI symptoms during the 6 months pre-diagnosis. Nasogastric (NG) feeding was recommended for 8 patients but continued in only 1. 15 patients (mean albumin 27 g/L) commenced parenteral nutrition (PN); 9 patients recovered, with albumin increasing over the 6-month follow-up. Mean hospital time was 62 days for the group receiving neither NG nor PN, compared with 124.3 for the PN/NG group (p = 0.04). In patients that died of EPS, albumin continued to fall at 3 months post-diagnosis.
CONCLUSION:
There is currently little guidance for nutritional management of EPS. From this study we recommend (1) a high level of clinical suspicion for EPS, especially if PD patients have weight loss; (2) PN may be better than NG feeding but further studies into dual enteral nutrition and PN are needed; (3) aggressive nutritional supplementation pre- and postoperatively; and (4) dietitians need to recognize the high risk of refeeding syndrome.
AuthorsDeclan de Freitas, Antoinette Jordaan, Rosalind Williams, Jane Alderdice, Janet Curwell, Helen Hurst, Alastair Hutchison, Paul E C Brenchley, Titus Augustine, Angela M Summers
JournalPeritoneal dialysis international : journal of the International Society for Peritoneal Dialysis (Perit Dial Int) 2008 May-Jun Vol. 28 Issue 3 Pg. 271-6 ISSN: 0896-8608 [Print] United States
PMID18474920 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Topics
  • Adult
  • Enteral Nutrition
  • Female
  • Humans
  • Intubation, Gastrointestinal
  • Kidney Failure, Chronic (complications, pathology, therapy)
  • Male
  • Middle Aged
  • Nutritional Status
  • Parenteral Nutrition
  • Peritoneal Dialysis (adverse effects)
  • Peritoneum (pathology)
  • Peritonitis (etiology, pathology, therapy)
  • Sclerosis (diagnosis, pathology)
  • United Kingdom
  • Weight Loss

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