Hamanoue Satoshi, Hoshino Junichi, Suwabe Tatsuya, Marui Yuji, Ueno Toshiharu, Kikuchi Koichi, Hazue Ryo, Mise Koki, Kawada Masahiro, Imafuku Aya, Hayami Noriko, Sumida Keiichi, Hiramatsu Rikako, Hasegawa Eiko, Sawa Naoki, Takaichi Kennmei, Ubara Yoshifumi
Nephrology Center, Toranomon Hospital, Tokyo, Japan.
Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
Ther Apher Dial. 2015 Jun;19(3):207-11. doi: 10.1111/1744-9987.12272. Epub 2015 Jan 22.
We evaluated the influence of kidney volume (KV) and liver volume (LV) on continuation of peritoneal dialysis (PD) in patients with autosomal dominant polycystic kidney disease (PKD). Twenty-two PKD patients on PD were retrospectively investigated after being divided into two groups. Group 1 comprised 15 patients who started PD at our hospital and group 2 was composed of seven patients referred from other hospitals for treatment of renomegaly by transcatheter arterial embolization (TAE) at 47.1 ± 21.8 months after commencing PD. In group 1, KV for both kidneys (mean ± SD) was 2787 ± 1945 mL (range: 1043 to 6816 mL), LV was 2198 ± 1139 mL (1005 to 4116 mL), and the total organ volume (TV=KV+LV) was 4985 ± 1815 mL (2320 to 8912 mL). In the patient with the largest TV from group 1 (KV of 6816 mL, TV of 8912 mL, and TV/BMI ratio of 426, PD was stopped due to dialysate leakage. However, dialysate leakage did not occur in the other 14 patients (TV ≦ 7963 mL and TV/BMI ratio of 353 at the start of PD). In group 2, KV was 5822 ± 1597 mL (3832 to 8862 mL), LV was 1776 ± 519 mL (1271 to 2671 mL), and TV was 7597 ± 1431 mL (5505 to 10358) before TAE. Leakage of dialysate did not occur with a mean infusion volume of 1530 ± 370 mL (1000 mL to 2000 mL), even after renomegaly and hepatomegaly progressed to the maximum TV/BMI ratio of 359. Six patients from the two groups developed new abdominal hernias at 36 ± 5 months (6-55 months) after starting PD. These findings suggest that performance of PD may be limited by renomegaly and hepatomegaly in patients with PKD.
我们评估了肾体积（KV）和肝体积（LV）对常染色体显性多囊肾病（PKD）患者继续进行腹膜透析（PD）的影响。对22例接受PD治疗的PKD患者进行回顾性研究，将其分为两组。第1组包括15例在我院开始PD治疗的患者，第2组由7例在开始PD治疗47.1±21.8个月后从其他医院转诊来接受经导管动脉栓塞术（TAE）治疗肾肿大的患者组成。在第1组中，双肾的KV（均值±标准差）为2787±1945 mL（范围：1043至6816 mL），LV为2198±1139 mL（1005至4116 mL），总器官体积（TV = KV + LV）为4985±1815 mL（2320至8912 mL）。在第1组中TV最大的患者（KV为6816 mL，TV为8912 mL，TV/BMI比值为426），因透析液渗漏而停止PD治疗。然而，其他14例患者（PD开始时TV≤7963 mL且TV/BMI比值为353）未发生透析液渗漏。在第2组中，TAE术前KV为5822±1597 mL（3832至8862 mL），LV为1776±519 mL（1271至2671 mL），TV为7597±1431 mL（5505至10358）。即使在肾肿大和肝肿大进展至最大TV/BMI比值为359后，平均注入量为1530±370 mL（1000 mL至2000 mL）时也未发生透析液渗漏。两组中有6例患者在开始PD治疗36±5个月（6至55个月）后出现新的腹疝。这些发现提示PKD患者中肾肿大和肝肿大可能会限制PD的实施。
