多囊肾大小与腹膜透析结局：与血液透析的比较
Polycystic kidney size and outcomes on peritoneal dialysis: comparison with haemodialysis.
作者信息
Courivaud C, Roubiou C, Delabrousse E, Bresson-Vautrin C, Chalopin J M, Ducloux D
机构信息
Department of Nephrology, Dialysis, and Renal Transplantation , University of Franche-Comté , Besançon , France ; Department of Nephrology, Dialysis, and Renal Transplantation , Saint-Jacques University Hospital , Besançon , France.
Department of Radiology , University of Franche-Comté , Besançon , France.
出版信息
Clin Kidney J. 2014 Apr;7(2):138-43. doi: 10.1093/ckj/sft171. Epub 2014 Feb 23.
BACKGROUND
For many nephrologists, patients with polycystic kidney disease (PKD) have an increased risk of complications and technique failure on peritoneal dialysis (PD) due to enlarged kidneys. The literature showed that PD can be as good a therapeutic option as haemodialysis (HD) for patients with PKD. However, no study has focused on the impact of polycystic kidney size on outcomes for patients on PD.
METHODS
This is a retrospective monocentric study. Fifty-eight patients with PKD started dialysis between January 2000 and December 2010: 24 on PD and 34 on HD. Kidney size assessed by abdominal computed tomography scans was available for 45 patients (19 on PD and 26 on HD). PD technique survival, specific PKD complications and mechanical and infectious PD complications, as need for pre-transplant nephrectomy and kidney transplantation, were considered.
RESULTS
The two cohorts were similar in terms of age and body surface area. The median kidney size was not significantly different between PD and HD patients [19.1 cm (12.5-32.5) versus 16.5 cm (11.8-33.8), respectively, P = 0.13]. However, we identified an increased number of PD patients with larger kidneys [(>25 cm) (27.8% on PD versus 7.7% on HD (P = 0.07)]. Neither cystic (infection or haemorrhage) nor mechanical complications (hernias and leaks) were different in PD or HD. Ten patients experienced PD-related peritonitis, mainly due to non-enteric bacterial pathogens. The main reason for stopping PD and HD was transplantation. Six PD patients underwent nephrectomy in order to access the transplant programme. Among them, five were maintained on PD after surgical procedure with good adequacy dialysis criteria.
CONCLUSIONS
We observed no deleterious impact of kidney size on outcomes on PD when compared with HD. A large kidney size in patients with PKD is not a contraindication to PD. Patients for whom a pre-transplant nephrectomy is mandatory can also safely opt for PD as a dialysis method.
背景
对于许多肾脏病学家而言，多囊肾病（PKD）患者因肾脏增大，腹膜透析（PD）出现并发症及技术失败的风险增加。文献表明，对于PKD患者，PD与血液透析（HD）一样是很好的治疗选择。然而，尚无研究关注多囊肾大小对接受PD治疗患者结局的影响。
方法
这是一项回顾性单中心研究。58例PKD患者于2000年1月至2010年12月开始透析：24例接受PD，34例接受HD。45例患者（19例接受PD，26例接受HD）可通过腹部计算机断层扫描评估肾脏大小。考虑了PD技术生存率、特定的PKD并发症以及PD的机械和感染性并发症，如移植前肾切除术和肾移植的需求。
结果
两组在年龄和体表面积方面相似。PD和HD患者的肾脏大小中位数无显著差异[分别为19.1 cm（12.5 - 32.5）和16.5 cm（11.8 - 33.8），P = 0.13]。然而，我们发现肾脏较大（>25 cm）的PD患者数量增加[PD组为27.8%，HD组为7.7%（P = 0.07）]。PD或HD患者的囊性并发症（感染或出血）和机械并发症（疝和渗漏）均无差异。10例患者发生与PD相关的腹膜炎，主要由非肠道细菌病原体引起。停止PD和HD的主要原因是移植。6例PD患者接受了肾切除术以进入移植程序。其中，5例在手术后维持PD治疗，透析充分性标准良好。
结论
与HD相比，我们观察到肾脏大小对PD结局无有害影响。PKD患者肾脏较大并非PD的禁忌证。对于必须进行移植前肾切除术的患者，也可安全地选择PD作为透析方法。
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