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Acquired cystic kidney disease in children undergoing continuous ambulatory peritoneal dialysis. Kyushu Pediatric
Insights
Acquired cystic kidney disease (ACKD) affects nearly 30% of children on continuous ambulatory peritoneal dialysis (CAPD), with prevalence increasing significantly with longer dialysis duration. Cyst progression and complications like bleeding were observed in some pediatric patients.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Medical Imaging
Background:
- Acquired cystic kidney disease (ACKD) is a known complication in adult patients undergoing long-term dialysis.
- The prevalence and characteristics of ACKD in pediatric populations, particularly those on continuous ambulatory peritoneal dialysis (CAPD), are less understood.
Purpose of the Study:
- To determine the prevalence, timing, and progression of ACKD in children undergoing CAPD.
- To investigate the relationship between ACKD and the duration of CAPD.
- To identify ACKD-related complications in this pediatric cohort.
Main Methods:
- A cross-sectional study involving 54 children on CAPD.
- Diagnosis of ACKD (≥4 cysts per kidney) and solitary cysts (SCs) (<4 cysts per kidney) using ultrasonography, CT, or MRI.
- Analysis of ACKD prevalence based on CAPD duration and cyst progression through serial imaging.
Main Results:
- ACKD was present in 29.6% of children, with initial detection at approximately 3 years of CAPD.
- The prevalence of ACKD significantly increased with longer CAPD duration (9.1% at 0-4 years, 50% at 5-9 years, 80% at >10 years).
- Cyst number and size increased in patients with ACKD and SCs over time; complications like gross hematuria and bleeding occurred in two patients.
Conclusions:
- Pediatric patients on CAPD have a high prevalence of ACKD, comparable to adults.
- ACKD prevalence, cyst burden, and complications are directly related to the duration of CAPD in children.
- Continuous monitoring and imaging are crucial for managing ACKD and its complications in children undergoing long-term dialysis.
Abstract:
Our cross-sectional study aims to elucidate the prevalence of acquired cystic kidney disease (ACKD), time of occurrence of ACKD, relationship between the prevalence of ACKD and duration of dialysis, progression of cysts, and ACKD-related complications in 54 children undergoing continuous ambulatory peritoneal dialysis (CAPD). ACKD was defined as four or more cysts detected in each kidney by ultrasonography, computed tomography (CT), or magnetic resonance imaging. The presence of less than four cysts was diagnosed as solitary cysts (SCs). Noncystic primary disease was present as glomerulonephritis in 23 patients (42.6%); hypoplastic kidney, 7 patients (13.0%); reflux nephropathy, 6 patients (11.1%); and other, 18 patients (33.3%). ACKD was evident in 16 patients (29.6%) during the 57.9 +/- 39.8 months after the start of CAPD. Nine patients (16. 7%) had SCs. SCs and ACKD were detected initially in patients with 1 and 3 years of CAPD, respectively. The mean duration of CAPD for patients with ACKD (96.1 +/- 36.6 months) differed from that of patients with SCs (49.8 +/- 29.9 months) and no cysts (38.3 +/- 25.8 months). The groups were classified according to time after the start of CAPD: 0 to 4 years (n = 33), 5 to 9 years (n = 16), and longer than 10 years (n = 5). The prevalence of ACKD among these three groups was 9.1%, 50%, and 80%, respectively, and this prevalence increased significantly with increasing duration of CAPD. Of 15 patients examined two to four times by ultrasonography or CT, the number and size of cysts increased in 7 patients with ACKD and 2 patients with SC. Two patients with many and large cysts experienced gross hematuria, and one of those patients had intracystic and retroperitoneal bleeding caused by cyst rupture. No solid mass lesion was found by imaging diagnostic modalities in the 54 patients. In conclusion, the prevalence of ACKD in children undergoing CAPD is just as high as that in adults. The prevalence of ACKD and number and size of cysts increased with increasing duration of CAPD.
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