Outcome of polycystic kidney disease patients on peritoneal dialysis: Systematic review of literature and meta-analysis

Abstract

BackgroundPolycystic kidney disease (PKD) is the most frequent hereditary cause of chronic kidney disease. Peritoneal dialysis (PD) is often avoided for patients with PKD because of the suspected risk of mechanical and infectious complications. Only a few studies have analyzed the outcome of PKD patients on PD with sometimes conflicting results. The purpose of this meta-analysis was to investigate outcomes of patients with PKD treated by PD.MethodsA systematic review and meta-analysis were performed examining all studies which included “Polycystic kidney disease” and “Peritoneal dialysis” in their titles, excluding commentaries, letters to the authors and abstracts. PubMed, Embase, Google scholar and Scopus were searched to December 31st 2017. The primary outcome was overall patient survival. Additional outcomes were PD technique survival, incidence of peritonitis and incidence of abdominal wall hernia.Results9 studies published between 1998 and 2016 were included for analysis with a total of 7,197 patients including 882 PKD patients. Overall survival of PKD patients was found to be better compared to non-PKD patients (HR = 0.70 [95% CI, 0.54–0.92]). There were no statistical differences between PKD and non-PKD patients in terms of peritonitis (OR = 0.86 [95% CI, 0.66–1.12]) and technical survival (HR = 0.98 [95% CI, 0.83–1.16]). There was an increased risk of hernia in PKD patients (OR = 2.28 [95% CI, 1.26–4.12]).ConclusionsPKD is associated with a better global survival, an increased risk of abdominal hernia, but no differences in peritonitis rate or technical survival were found. PD is a safe dialysis modality for PKD patients. Properly designed controlled studies are needed to determine whether all PKD patients are eligible for PD or whether some specific criteria should be determined.

Creating and Maintaining Optimal Peritoneal Dialysis Access in the Adult Patient: 2019 Update

“…Peritoneal dialysis is often avoided in polycystic kidney disease (PKD) patients because of concerns about limited peritoneal space, peritonitis, and hernias. Recent studies support the feasibility of PD in most PKD patients (109)(110)(111)(112)(113)(114). Despite crowding of the peritoneal space with enlarged cystic kidneys, there is no significant difference between PKD patients and non-PKD patients without diabetes for dialysis adequacy and patient and technique survival.…”

Patients’ outcome with polycystic kidney disease firstly treated with peritoneal dialysis. Experience of our home dialysis unit since 1997.

“…Les résultats de notre étude rétrospective mono-centrique comportant 30 patients sont favorables à la prise en charge en dialyse péritonéale (DP) des patients PKAD, avec possiblement une sélection des patients PKAD selon le volume des reins lors de leur orientation vers une modalité de dialyse. Nous avons confronté notre expérience aux résultats des deux registres Français de dialyse, le réseau REIN pour l'ensemble des patients dialysés et le registre RDPLF de la dialyse à domicile (années 2000 -2010), qui ont été publiés conjointement en septembre 2017 [1], et à ceux de deux méta-analyses récentes regroupant respectivement 9 et 12 études [5,6], majoritairement rétrospectives, souvent mono-centriques. Ces deux méta-analyses se sont essentiellement intéressées à la survie des patients et à celle de la technique de dialyse ainsi qu'aux infections péritonéales, toutes méthodes de DP confondues.…”

“…Dans les registres Français la prise en charge en DP des patients PKAD est associée à une meilleure probabilité d'accès à la transplantation rénale [1]. Les deux méta-analyses publiées en DP [5,6] regroupant respectivement 882 et 931 patients PKAD montrent des résultats similaires en faveur de la prise en charge en DP de ces patients, en particulier pour la survie (meilleure en cas de PKAD) et la survie de la méthode de dialyse qui n'est pas différente des groupes contrôles (patients non PKAD). Une meilleure survie des patients PKAD en DP est aussi observée dans les registres Français de dialyse [1].…”

“…Dans notre centre, le taux de péritonite varie selon les années entre un épisode tous les 31 à 35 mois-patients et la fréquence des infections à bacille gram négatifs est estimée à 25% chez les patients non PKAD (données non publiées). Dans les deux méta-analyses[5,6] la fréquence des péritonites n'est pas plus importante dans la population de patients PKAD que dans la population non PKAD.…”

Autosomal dominant polycystic kidney disease and pioglitazone for its therapy: a comprehensive review with an emphasis on the molecular pathogenesis and pharmacological aspects

“…This is another very troublesome extra-renal complication of ADPKD that is very prevalent (Dupont et al 2018 ). A study involving the comparison of renal failure patients with and without ADPKD found the abdominal hernia prevalence of 45% (38/85) and 8% (7/85) in patients with renal failure with and without ADPKD, respectively (Mikolajczyk et al 2017 ).…”