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.