Comparative Study of Outcomes among Patients with Polycystic Kidney Disease on Hemodialysis and Peritoneal Dialysis

Abstract

Polycystic kidney disease (PCKD) is the most common hereditary cause of end-stage renal disease, the complications of which may prevent the choice of peritoneal dialysis (PD). The aim of this study was to explore the effects of dialysis modality on outcomes in patients with PCKD. We extracted a cohort of 1417 adult patients with PCKD initiating long-term dialysis therapy in 1999–2010 from the Taiwan National Health Insurance Research Database, among which 125 patients chose PD. The patients on HD were older and had a higher comorbidity index compared to those on PD. We compared the risks for death, hospitalization and medical expenditures between the patients on PD and propensity-score matched patients on hemodialysis (HD). The overall survival did not differ between the patients on PD and HD. The patients on PD tended to have higher hazard ratios (HR) for the first episode of hospitalization (adjusted HR 1.34 [95% CI, 1.04−1.79]). The annual medical expenses were 10% lower for the patients on PD. PD is an equivalent choice of renal replacement therapy to HD for patients with PCKD in terms of survival. Although the patients on PD had a higher risk for hospitalization, the medical expenditure for PD was 10% lower.

Dialysis modality and mortality in polycystic kidney disease

“…After exclusion of irrelevant studies and duplicates, 24 potentially eligible studies were deeply screened. Eventually, eight studies involving 7685 PKD patients were included for final meta‐analysis . Characteristics of included studies were listed in Table .…”

“…The follow‐up duration ranged from 3 years to 22 years . Two studies were performed in Europe, five studies were in Asia, and one study in America. The patients in PD group included continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) modalities.…”

“…However, a recent cohort study showed that PD were comparable to HD in ADPKD patients in terms of overall survival and complications . Furthermore, several long‐term follow‐up studies from Asia compared HD with PD in ADPKD recently . Therefore, we aimed to use meta‐analysis to summarize the present evidence evaluating the outcome of different dialysis modalities in PKD.…”

Is Peritoneal Dialysis a Suitable Renal Replacement Therapy Option for Polycystic Kidney Disease Patients?

“…The all-cause mortality between patients with PKD on PD and HD 4 studies [19,25,39,40] with a total of 5, 762 patients reported the all-cause mortality between patients with PKD on PD and HD. The all-cause mortality did not differ between the PKD patients on PD and HD (RR: 0.87, 95%CI: 0.72-1.06) with no heterogeneity (I 2 =7.7%, P=0.355) (Fig.…”

“…The main features of the studies on the adverse outcomes for all articles in Table 1. 7 studies [16-19, 21, 24, 39] were conducted in Europe, with the exception of seven [9,20,22,23,25,26,40] conducted in Asia. Patients' age in PKD ranged from 35.4 to 63.6 years old, however, patients' age in non-PKD was higher than PKD, ranged from 46 to 61 years old.…”