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Publication:
Author Interview: Dr Kai Ming Chow, MBChB, FRCP

Peritoneal Dialysis as the First-line Renal Replacement Therapy in Patients With Autosomal Dominant Polycystic Kidney Disease

Lin Li, Cheuk-Chun Szeto, Bonnie Ching-Ha Kwan, Kai-Ming Chow, et al.
June 2011 American Journal of Kidney Diseases Vol. 57, Issue 6, Pages 903-907

We demonstrated good 5-year actuarial (71.0%) and technique (51.6%) survival of autosomal dominant polycystic kidney disease (ADPKD) patients on peritoneal dialysis, comparable to a group of matched non-diabetic patients on peritoneal dialysis within the same dialysi scentre.

Although ADPKD patients on peritoneal dialysis had increased odds of abdominal wall hernia, their risk of peritonitis was similar to other non-diabetic peritoneal dialysis subjects. 

Controversy prevails as to whether ADPKD patients should be started on peritoneal dialysis, given the theoretical risk of diverticulitis (and hence excess peritonitis risk) and technique failure.

Our study is not the last word on the subject, but it is surprising to see the reassuring peritoneal dialysis treatment results in ADPKD patients.

Clinicians should offer the choice of haemodialysis AND peritoneal dialysis to ADPKD patients who needed dialysis. A codicil to the choice of peritoneal dialysis is careful physical examination (and informed risk) of abdominal hernia

Conventional wisdom (or misconception) holds that peritoneal dialysis is contraindicated in ADPKD patients. This should be revisited. Notwithstanding the practical issue of hernia, peritoneal dialysis can be safely considered for ADPKD patients under experienced hands.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary cause of kidney failure. Peritoneal dialysis (PD) often is avoided because of concerns about hernias and peritonitis.

Study Design

Retrospective matched-cohort study.

Setting & Participants

42 consecutive patients with ADPKD and 84 nondiabetic patients matched by time of PD therapy initiation.

Predictors

ADPKD and comorbid conditions.

Outcomes

Patient survival, technique survival, peritonitis-free survival; peritonitis rate; abdominal hernias.

Measurements

Dialysis adequacy and nutritional indexes; rate of decrease in residual renal function; bacteriologic cause of peritonitis.

Results

5-year actuarial survival of the ADPKD and control groups was 71.0% and 69.7% (P = 0.4), whereas technique survival was 51.6% and 37.3%, respectively (P = 0.2). There was no difference in overall rates of peritonitis between the ADPKD and control groups (0.51 vs 0.53 episodes/patient-year; P = 0.3), and the incidence of Gram-negative peritonitis also was similar (0.16 vs 0.14 episodes/patient year; P = 0.5). Abdominal wall hernia was significantly more common in the ADPKD than control group (14 vs 6 cases; P < 0.001), but all patients were able to resume PD therapy after surgical repair.

Limitations

Retrospective study with limited sample size.

Conclusion

PD is a feasible treatment option for most patients with ADPKD with end-stage renal disease. Although patients with ADPKD have a higher risk of abdominal wall hernia, their overall survival rate and risk of peritonitis are similar to those of other nondiabetic PD patients.

Peritoneal Dialysis as the First-line Renal Replacement Therapy in Patients With Autosomal Dominant Polycystic Kidney Disease