Peritoneal dialysis for autosomal dominant polycystic kidney disease: a retrospective study

Xie, Xueping; Xie, Zhoutao; Xiang, Shilong; Yan, Xingqun; Zhang, Xiao-Hui; Shou, Zhangfei; Chen, Jianghua

doi:10.1631/jzus.b1500235

Cited by 6 publications

(17 citation statements)

References 21 publications

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“…PD was found to be a feasible treatment for most ADPKD patients with ESRD, although ADPKD patients had a higher risk of abdominal wall hernia. Xie et al [48] obtained similar results to ours in 30 ADPKD patients.…”

Section: Management Of Adpkdsupporting

confidence: 88%

The Clinical Manifestation and Management of Autosomal Dominant Polycystic Kidney Disease in China

Xue

Zhou

et al. 2016

Kidney Dis

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Background: Autosomal dominant polycystic kidney disease (ADPKD) is the most common monogenic hereditary kidney disease characterized by progressive enlargement of renal cysts. The incidence is 1-2‰ worldwide. Mutations in two genes (PKD1 and PKD2) cause ADPKD. Currently, there is no pharmaceutical treatment available for ADPKD patients in China. Summary: This review focused on advances in clinical manifestation, gene diagnosis, risk factors, and management of ADPKD in China. There is an age-dependent increase in total kidney volume (TKV) and decrease in renal function in Chinese ADPKD patients. ADPKD is more severe in males than in females. Great progress has been made in molecular diagnosis in the last two decades. Nephrologists found many novel PKD mutations in Chinese ADPKD patients early through polymerase chain reaction, and then through liquid chromatography in 2000s, and recently through next-generation sequencing. Major predictive factors for ADPKD progression are age, PKD genotype, sex, estimated glomerular filtration rate (eGFR), and TKV. With respect to the management of ADPKD, inhibitors targeting mTOR and cAMP are the focus of clinical trials. Triptolide has been used to treat ADPKD patients in clinical trials in China. Triptolide significantly protected eGFR of ADPKD patients compared with placebo. Key Messages: ADPKD affects about 1.5 million people in China. An additional PKD gene besides PKD1 and PKD2 was not found in the Chinese. The prevalence of intracranial aneurysm in Chinese ADPKD patients was 12.4%. The predictive factors for eGFR decrease in Chinese ADPKD patients are TKV, proteinuria, history of hypertension, and age. The treatment strategies in clinical trials for ADPKD patients in China are similar to those in the West except for triptolide. Facts from East and West: (1) ADPKD is diagnosed globally by ultrasound detection of kidney enlargement and presence of cysts. Recent analyses of variants of the PKD1 and PKD2 genes by next-generation sequencing in Chinese and Western ADPKD patients might lead to the development of reliable genetic tests. (2) Besides lifestyle changes (low-salt diet, sufficient fluid intake, and no smoking), blood pressure control is the primary nonspecific treatment recommended by Kidney Disease - Improving Global Outcomes (KDIGO) for ADPKD patients. How low the blood pressure target should be and what the means of achieving it are remain open questions depending on the severity of chronic kidney disease and the age of the patients. In a recent Chinese study, diagnostic needle aspiration and laparoscopic unroofing surgery successfully improved infection, pain, and hypertension. Peritoneal dialysis was found to be a feasible treatment for most Chinese ADPKD patients with end-stage renal disease. In most Western centers, patients without contraindication are selected for peritoneal dialysis. Kidney transplantation with concurrent bilateral nephrectomy was successful in relieving hypertension and infection in Chinese ADPKD patients. In Western countries, sequential ...

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Section: Management Of Adpkdsupporting

confidence: 88%

The Clinical Manifestation and Management of Autosomal Dominant Polycystic Kidney Disease in China

Xue

Zhou

et al. 2016

Kidney Dis

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“…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.…”

Section: Literature Searchmentioning

confidence: 99%

“…The outcomes in PKD and non-PKD patients on PD Dialysis adequacy. For the 9 studies [9,16,17,[21][22][23][24][25][26] which examined the association of Kt/V in PKD and non-PKD patients and 4 studies [16,22,24,26] examined the association of dialysate to-plasma ratios of creatinine (D: Pcr) at 4h in PKD and non-PKD patients. Whether Kt/V or D: Pcr (4h), there was no difference in terms of dialysis adequacy for each other (Kt/V, SMD: -0.02, 95% CI: -0.12-0.08; D: Pcr (4h), SMD: -0.10, 95%CI: -0.26-0.06).…”

Section: Literature Searchmentioning

confidence: 99%

“…Technique failure was defined as a permanent cessation of PD due to PDrelated complications. 5 studies [16,20,21,24,26] examined the association of technique failure in PKD and non-PKD patients on PD. We found that there was no significantly statistical difference on technique failure in PKD and non-PKD patients on PD (RR: 0.97, 95%CI: 0.78-1.20) without heterogeneity (Fig.…”

Section: Literature Searchmentioning

confidence: 99%

“…In recent years, scale observational studies [16][17][18][19][20] suggested that PKD was not a contraindication for PD. Moreover, it has even been suggested that PD may be associated with a better prognosis in PKD than that of non-PKD patients [9,16,17,19,[21][22][23][24][25][26]. Therefore, it has raised concern as to whether PD is appropriate for PKD patients.…”

Section: Introductionmentioning

confidence: 99%

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

Zhang¹,

Dou²,

Wang³

et al. 2018

Kidney Blood Press Res

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Background/Aims: Mounting clinical experience and evidence from scale observational studies have suggested that polycystic kidney disease (PKD) was not a contraindication for peritoneal dialysis (PD). Recent studies have reported that PD may be associated with a better prognosis in PKD than that of non-PKD patients. To solve the problem, we performed a systematic review and comprehensive meta-analysis to compare the outcomes between PKD and non-PKD patients on PD and the all-cause mortality between patients with PKD on PD and hemodialysis (HD). Methods: We conducted a systematic literature using electronic databases (PubMed, Ovid, Embase and Web of Science) to identify the studies reporting the endpoint events of PKD/non-PKD patients with PD and the all-cause mortality between patients with PKD on PD and HD, such as dialysis adequacy, technique failure, PD-related complications, the mode of RRT change, and all-cause mortality. We searched the literature published February 2018 or earlier. We used both fix-effects and random-effects models to calculate the overall effect estimate. A sensitivity analysis and subgroup analysis were performed to find the origin of heterogeneity. Results: 12 studies with a total of 17,040 patients reported the endpoint events of PKD/non-PKD patients with PD. No significant difference was observed on dialysis adequacy (Kt/V, SMD: -0.02, 95%CI: -0.12–0.08; D: Pcr (4h), SMD: -0.10, 95% CI: -0.26–0.06), technique failure (RR: 0.97, 95%CI: 0.78-1.20), RRT change (RR: 0.96, 95%CI: 0.77-1.19), total PD-associated complications (RR: 1.0, 95%CI: 0.91-1.09) and all-cause mortality (RR: 0.40, 95%CI: 0.33–0.47) in PKD patients, compared with non-PKD subjects undergoing PD. However, the proportion of renal transplantation in PKD patients was higher than that of non-PKD patients (RR: 2.04, 95%CI: 1.88–2.20) with significant heterogeneity (I2 =82.7%, P=0.000). 4 studies with a total of 5,762 patients reported that the all-cause mortality did not differ between the PKD patients on PD and HD (RR: 0.87, 95%CI: 0.72-1.06). Conclusion: Our meta-analysis found that the outcomes of given population of PKD patients on PD were at least not inferior as compared to those with other primary kidney diseases, and suggested that PKD might be not absolutely a contraindication for PD. Given the limitations of the proposed, it needs further large-scale studies to assess whether PD is a suitable RRT option for end-stage renal disease (ESRD) patients with PKD.

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Identification of the Factors Associated With Intraperitoneal Pressure in ADPKD Patients Treated With Peritoneal Dialysis

Sigogne

Kanagaratnam

Mora

et al. 2020

Kidney International Reports

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Introduction: Peritoneal dialysis (PD) is reported to be underused in the autosomal dominant polycystic kidney disease (ADPKD) population because doctors fear technical failure caused by reduced abdominal space and high intraperitoneal pressure (IPP). Methods:We designed a multicenter retrospective study to be carried out in 15 French centers recruiting 60 patients with ADPKD treated with PD to identify factors associated with IPP. Inclusion criteria were start of PD between 2010 and 2017, available tomodensitometry, and IPP measurement in the first year of dialysis. The clinical and radiological data for each patient were reviewed by the same operator. Total kidney volume (TKV), liver volume, and the volume of the abdominal cavity were measured using contouring.Results: TKV and the volume of the abdominal cavity in women and men were, respectively, 2397 ml versus 3758 ml and 9402 ml versus 12,920 ml. In the univariate analysis, IPP was significantly and positively associated with body surface area (P ¼ 0.0024), body mass index (BMI) (P < 0.0001), the volume of the abdominal cavity (P ¼ 0.0005), and the volume of the dialysate infused in the peritoneal cavity (IPV) (P ¼ 0.0108). In the multivariate analysis, only BMI was still significantly associated with IPP (P ¼ 0.0004) Conclusions: Our results identified BMI as the main factor linked to IPP in patients with ADPKD. Despite a reliable assessment of the volume of their organs we did not find any correlation between liver and kidney volumes and IPP. To our knowledge, this is the first study designed to identify factors associated with IPP in patients with ADPKD on PD.

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Peritoneal dialysis for autosomal dominant polycystic kidney disease: a retrospective study

Cited by 6 publications

References 21 publications

The Clinical Manifestation and Management of Autosomal Dominant Polycystic Kidney Disease in China

The Clinical Manifestation and Management of Autosomal Dominant Polycystic Kidney Disease in China

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

Identification of the Factors Associated With Intraperitoneal Pressure in ADPKD Patients Treated With Peritoneal Dialysis

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