Peritoneal Dialysis Outcomes in Autosomal Dominant Polycystic Kidney Disease.

KEY POINTS: Peritoneal dialysis can be used successfully in patients with autosomal dominant polycystic kidney disease. Compared with days receiving hemodialysis, peritoneal dialysis days were associated with better patient survival, which has increased over time. Compared with hemodialysis days, peritoneal dialysis days were associated with a higher rate of kidney transplant, which has increased over time.

BACKGROUND

Peritoneal dialysis (PD) is a form of home dialysis that is underutilized in the United States. Patients with autosomal dominant polycystic kidney disease (ADPKD) are frequently good PD candidates who are often young and have few comorbid conditions. However, clinicians may be hesitant to recommend PD to patients with ADPKD because of perceived concerns for mechanical complications and technique failure. Little is known about outcomes of patients with ADPKD undergoing PD in the United States.

METHODS

A retrospective cohort of patients with ESKD 30 years and older registered in the United States Renal Data System with a diagnosis of cystic kidney disease from January 1, 2000, to December 31, 2021, was followed until death or January 1, 2023, whichever occurred first. A time-dependent variable for kidney treatment modality was created, allowing calculation of hazard ratios (HRs) and confidence intervals (CIs) on the basis of time proximity of PD exposure to death and kidney transplantation, compared with hemodialysis. Cox models were adjusted for age, sex, race, body mass index, serum albumin, hemoglobin, year of incident ESKD, insurance status, and comorbid conditions at the time of inclusion.

RESULTS

Among 53,651 incident ADPKD patients with ESKD, 26% received some PD. Over a median follow-up of 75 months, 26,375 (49%) of the patients received kidney transplants and 23,427 (44%) died. PD exposure was more likely among patients with ADPKD who were younger, were female, and had lower burden of comorbid diseases. In the adjusted models, PD was associated with lower mortality (HR, 0.84; 95% CI, 0.80 to 0.88, P < 0.001) and higher likelihood of transplant (HR, 1.12; 95% CI, 1.08 to 1.16; P < 0.001) compared with hemodialysis. The associations with lower mortality and higher transplantation became progressively more prominent with each passing year.

CONCLUSIONS

These data indicate that PD is a safe and advantageous dialysis option for patients with ADPKD that is associated with longer patient survival and opportunities for kidney transplant.