Peritoneal Dialysis Outcomes in Autosomal Dominant Polycystic Kidney Disease
Samantha Gunning, Rita L. McGill, Arlene B. Chapman, Pranav S. GarimellaBackground:
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 ADPKD patients due to perceived concerns for mechanical complications and technique failure. Little is known about outcomes of ADPKD patients undergoing PD in the United States.
Methods:
A retrospective cohort of end stage kidney disease (ESKD) patients ≥30 years old registered in the US Renal Data System with a diagnosis of cystic kidney disease from 1/1/2000-12/31/2021 was followed until death or 1/1/2023. A time-dependent variable for kidney treatment modality was created, allowing calculation of hazard ratios (HR) and confidence intervals (CI) based on time-proximity of PD exposure to death and kidney transplantation, compared to hemodialysis (HD). 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 patients received kidney transplants and 23,427 (44%) died. PD exposure was more likely among ADPKD patients who were younger, female, and who had lower burden of comorbid diseases. In the adjusted models PD was associated with lower mortality [HR: 0.84, 95% CI=0.80-0.88, P<0.001] and higher likelihood of transplant [HR:1.12, 95% CI=1.08-1.16, P<0.001] compared to HD. The associations with lower mortality and higher transplantation became progressively more prominent with each passing year.
Conclusion:
These data indicate that PD is a safe and advantageous dialysis option for ADPKD patients that is associated with longer patient survival and opportunities for kidney transplant.