September 02, 2025
2 min read
Key takeaways:
- Infection rates stayed within International Society for Peritoneal Dialysis guideline thresholds during the study.
- The most prevalent complications were abdominal hernia and peritonitis.
Peritoneal dialysis is safe for patients with autosomal dominant polycystic kidney disease, with no added risk associated with larger organ volumes, according to study data.
“Autosomal dominant PKD (ADPKD) is the most prevalent genetic kidney disorder and the fourth leading cause of kidney failure, with 50% of patients reaching kidney failure by their sixth decade of life,” Fadi George Munairdjy Debeh, MD, a nephrology research fellow at Mayo Clinic Florida, and colleagues wrote. “PD is a widely used modality for kidney replacement therapy in patients with kidney failure.” However, use of PD by patients with ADPKD is low because of the “theoretical risk that enlarged kidneys can impair a patient’s ability to tolerate sufficient intraperitoneal volume to achieve adequate dialysis clearance.”
Data derived from
Munairdjy Debeh FG, et al. Kidney360. 2025;doi:10.34067/KID.0000000888.
The researchers aimed to assess PD use by adults with ADPKD, focusing on cumulative cystic organ volumes and treatment complications. The retrospective cohort study used the Mayo Clinic PKD database to evaluate data from 155 patients with ADPKD on PD.
Overall, 45.1% of patients were men, mean age at PD initiation was 54.3 years and mean BMI was 28 kg/m². The median duration of PD treatment was 24.3 months, during which 21.9% of patients transitioned to hemodialysis.
The researchers assessed demographic, clinical and PD-related outcomes of patients on PD at multiple Mayo Clinic sites from 1990 to 2024.
The most prevalent complications were abdominal hernia (30.3%) and peritonitis (23.9%), according to the findings. The peritonitis rate was 0.11 episodes per patient-year.
Imaging results before beginning PD indicated a median height-adjusted total kidney liver volume of 2,731.9 mL/m and a 1,303.5 mL/m median height-adjusted total kidney volume.
Analysis showed no significant differences in complication rates associated with median height-adjusted total kidney liver volume or median height-adjusted total kidney volume, or across BMI categories. Greater height-adjusted cumulative organ volumes were linked to lower risk for PD-related complications (HR = 0.56).
Overall, the study supports PD safety, with infection rates staying within International Society for Peritoneal Dialysis guideline thresholds, according to the researchers.
“In conclusion, this study demonstrates that PD is a safe and feasible option for patients with ADPKD, even with high cystic organ volumes,” the researchers wrote. “Larger organ volumes, including height-adjusted cumulative kidney and liver volume, were not associated with increased PD-related complications. Complication rates, including peritonitis and abdominal wall hernias, were low, reflecting the impact of rigorous infection prevention and patient education. While limited by its retrospective design and lack of control groups, these findings support the feasibility of PD in ADPKD and highlight the need for future prospective studies to further refine treatment strategies.”
Perspective
The findings of this study strengthen the evidence supporting the use of PD for patients with ADPKD who transition to dialysis.
PD is prescribed with utmost caution in patients with a history of abdominal surgeries or comorbidities involving abdominal organs, such as ADPKD. This careful approach is based on the belief that higher kidney and liver volume may increase intraperitoneal pressure, potentially leading to an inability to tolerate PD fluid and subsequent complications. The authors’ report on 155 individuals with ADPKD on PD, with a median time and complications like peritonitis and abdominal wall hernia, were similar in patients without ADPKD, further reinforcing the cautious prescription of PD.
In the subset of patients with ADPKD who had imaging available within 3 years of PD initiation, height-adjusted total kidney liver volume (htTKLV) and height-adjusted total kidney volume (htTKV) were calculated. The regression analysis showed no differences in complication rates based on htTKLV or htTKV (above vs. below median values) or BMI categories.
Comparing the organ volumes between PD and hemodialysis patient cohorts revealed that the hemodialysis cohort had higher volumes, although it was also older. Additionally, higher height-adjusted cumulative organ volume was associated with a lower risk for PD-related complications. A possible reason for this observation could be the selection of patients who initiated PD. As evident by the significant difference at the 75th percentile, where patients in the hemodialysis group had substantially higher htTKV.
This study establishes the overall safety of PD as a dialysis modality in the ADPKD population. However, it also highlights the need for additional studies to evaluate the impact of PD prescription on complication rates and to capture additional complications, such as abdominal discomfort, catheter dysfunction, catheter-related intervention or hemoperitoneum.
Disclosures: Gupta reports no relevant financial disclosures.
Sources/Disclosures
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Disclosures:
Munairdjy Debeh reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
