Renin Angiotensin System Inhibition may Prevent Progression of Encapsulated Peritoneal Sclerosis

Encapsulated Peritoneal Sclerosis (EPS) is a devastating complication of long-term peritoneal dialysis (PD) patients. Angiotensin-2 is a well-known agent that promotes fibrosis and inflammation in the course of various inflammatory diseases. We aimed to investigate the effects of enalapril (ENA), valsartan (VAL) and ENA plus VAL (COMB) on the progression (P) of EPS induced by chlorhexidine gluconate (CG). Forty-two non-uremic wistar albino rats were divided into five groups: Control group: 2 ml isotonic saline intraperitoneally (IP) daily, CG group: IP 2 ml/200 g injection of CG (0.1%) and ethanol (15%) dissolved in saline; All treatment groups received CG solution plus the following: ENA-P group: 100 mg/L ENA, VAL-P group: 640 mg/L VAL, COMB-P group: 100 mg/L ENA + 640 mg/L VAL, given daily for 3 weeks in drinking water. ENA and VAL have beneficial effects on peritoneal functional and morphological alterations induced by CG via inhibition of neoangiogenesis, increased UF volume and decreased peritoneal thickness and dialysate cell count. Dual blockage of renin angiotensin system (RAS) has no additional benefits except improved peritoneal thickness.