Factors Influencing Cyst Infection in Autosomal Dominant Polycystic Kidney Disease

Abstract

Background: Cyst infection is a frequent and serious complication of autosomal dominant polycystic kidney disease (ADPKD) that is often difficult to treat. However, the factors influencing cyst infection are still unknown. Therefore, we investigated clinical factors related to the duration of hospitalization and death due to cyst infection. Methods: All ADPKD patients undergoing cyst drainage or nephrectomy or partial hepatectomy at Toranomon Hospital from January 2004 to March 2016, in whom cyst fluid analysis showed bacteria or neutrophils indicating definite cyst infection, were reviewed retrospectively. Factors influencing the duration of hospitalization and death due to cyst infection were analyzed. Results: A total of 243 patients with cyst infection were enrolled, including 104 men and 139 women (mean age: 62.6 ± 10.0 years). Seventeen patients died of cyst infection. Multivariate logistic regression analysis revealed that hepatomegaly, positive cyst contents culture, and the maximum white blood cell (WBC) count were significantly associated with death from cyst infection. Death was significantly more likely if patients had massive hepatomegaly (≥5,113.2 mL) compared with mild hepatomegaly (< 1,898.7 mL; odds ratio 38.1; 95% CI 2.9–492.6, p = 0.0004). Multivariate Cox proportional hazards analysis revealed that older age, dialysis duration, hepatic transcatheter arterial embolization, maximum WBC count, and hepatomegaly were significantly associated with longer hospital stay for cyst infection, while female sex, nephrectomy, serum albumin, and serum cholinesterase were significantly associated with shorter hospital stay. Discharge alive from hospital was significantly associated with massive hepatomegaly versus mild hepatomegaly (hazard ratio 0.0072; 95% CI 0.0008–0.0659, p < 0.0001). Conclusions: Hepatomegaly was strongly associated with both death and longer hospital stay due to cyst infection.

Cyst infection in autosomal dominant polycystic kidney disease: our experience at Toranomon Hospital and future issues

“…In contrast to renal TAE, hepatic TAE may not prevent hepatic infection at all. In addition, hepatic TAE was not significantly associated with death from cyst infection, but it was significantly associated with a longer hospitalization duration in our series [23]. This may be because hepatic arteries are occluded only partially by hepatic TAE, and the invasion of bacteria into hepatic cysts through hepatic arteries is thus not prevented.…”

“…We investigated the clinical factors related to the duration of hospitalization and death due to cyst infection [23]. All ADPKD patients who underwent cyst drainage, nephrectomy or partial hepatectomy at Toranomon Hospital from January 2004 to March 2016 in whom a cyst fluid analysis showed bacteria or neutrophils indicating definite cyst infection were retrospectively reviewed.…”

“…However, water-soluble antibiotics are usually effective for managing mild cyst infection. Indeed, there are some articles that have reported the effectiveness of water-soluble antibiotics for cyst infection in ADPKD [5,21,23,40]. Shankar et al reported that severe emphysematous polycystic infection by Klebsiella pneumoniae was treated by penicillin [40].…”

“…We previously reported that the incidence of renal cyst infection might decrease if adequate renal volume (RV) reduction can be achieved by renal TAE [ 10 , 23 ]. From 2004 to 2016, 807 patients underwent renal TAE in our hospital, 16 of whom (2.0%) had definite renal cyst infection.…”

Somatostatin analog therapy effectiveness on the progression of polycystic kidney and liver disease: A systematic review and meta-analysis of randomized clinical trials

“…TLV and TKV are considered important clinical outcomes in patients with PKD because they are closely related to their quality of life [26,27]. As the kidney or liver volume may be associated with complications of PKD, such as cyst infection, these outcomes could also predict morbidity and mortality [28]. As the baseline characteristics of the patients are variable (e.g., absolute TLV, TKV and age), we decided to conduct a meta-analysis using change in percentage of TLV and TKV between baseline and follow up (ΔTLV% or ΔTKV%) instead of the absolute value of TLV or TKV, as the change in percentage could be less influenced by the variability in baseline characteristics across studies.…”