Is peritoneal dialysis a suitable renal replacement therapy in autosomal dominant polycystic kidney disease?

This commentary discusses a study reported by Kumar et al. that compared outcomes of 56 patients with autosomal dominant polycystic kidney disease (ADPKD) started on peritoneal dialysis with those of a control group of nondiabetic patients matched for age, sex and year of starting peritoneal dialysis. During follow-up (mean 37 months), patient survival, technique survival and peritonitis rates were similar in the two groups. Peritoneal dialysis was not only possible but was also successful in 68% of patients. Although the study was well conducted and the results very encouraging, it did not address the relevant clinical issue of whether peritoneal dialysis is a less desirable option than hemodialysis in some patients with ADPKD, for example those with very large, cystic kidneys and/or a very large, cystic liver. Further studies to investigate renal replacement modalities in patients with ADPKD should relate study outcomes to the volumes of patients' kidneys and liver.