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

Background 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.