말기 신부전으로 진행된 다낭성 신증 환자에서 신대체 요법간의 비교

Abstract

Background : Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common genetic disorder that accounts for 8-10% of patients receiving renal replacement therapy in Unites States and Europe, and approximately 2% in Korea. ADPKD patients on renal replacement therapy constitute a particular group with typical clinical characteristics and differences from other patients on renal replacement therapy. The objective of this study was to assess clinical features, morbidity, mortality and technical survival in end stage renal disease (ESRD) patients with ADPKD and compare these between each renal replacement therapy. Methods : We retrospectively analyzed 70 ADPKD patients who received renal replacement therapy in Yonsei university medical center (Jan. 1980-Dec. 2001) Results : Among a total of 70 patients, 41 patients were male and 29 patients were female. Mean age was 45.6±10.7 years and average time from diagnosis of ADPKD to start of renal replacement therapy was 5.1±5.6 years. As the initial mode of renal replacement therapy, 25 patients started on hemodialysis 26 patients started on CAPD and 19 patients received renal transplantation. Clinical features and laboratory findings at the initiation of renal replacement therapy had no significant differences between each renal replacement therapy. Cumulative and technical survival in ESRD patients with ADPKD receiving each renal replacement therapy had no significant differences according to Kaplan-Meier. Seven patients died within study period, including 3 hemodialysis patients, 2 CAPD patients and 2 renal transplantation patients. The most common cause of death was infection followed by bleeding and malignancy, Among patients on CAPD, 10 patients had stepped CAPD because of peritonitis, hernia, ultrafiltration failure and CAPD leakage. Conclusion : In summary, there were no significant differences of clinical features, cumulative and technical survival between each renal replacement therapy in ADPKD patients. The most frequent reason for cessation of CAPD was peritonitis, The most common cause of death was infection in ESRD patients with ADPKD.