Polycystic Kidney Disease and End-Stage Renal Disease Treatment

Primary Treatment Recommendation

• The American College of Cardiology is not mentioned, however, Kidney transplantation should be considered the preferred treatment option for PKD patients progressing to ESRD, as it offers superior outcomes in terms of mortality and quality of life compared to dialysis 1

Timing of Renal Replacement Therapy

• Dialysis initiation should be based on clinical symptoms rather than GFR alone, with consideration of symptoms or signs attributable to kidney failure, and should occur when one or more of the following are present, according to the American Journal of Kidney Diseases 2, 1
• Cognitive impairment is a factor to consider when deciding to start dialysis, as stated by the American Journal of Kidney Diseases 3
• The decision to start dialysis typically occurs when GFR is between 5-10 mL/min/1.73 m², though symptoms should drive the decision, not the number alone, as recommended by the American Journal of Kidney Diseases 2

Transplantation as First-Line Therapy

• Living donor preemptive kidney transplantation should be considered when GFR falls below 20 mL/min/1.73 m² with evidence of progressive and irreversible CKD over 6-12 months, according to the American Journal of Kidney Diseases and Praxis Medical Insights 2, 1

Dialysis Modality Selection

• For hemodialysis, a target Kt/V of 1.4 per session (minimum 1.2) with sessions lasting at least 3 hours for patients with minimal residual renal function is recommended by Praxis Medical Insights 1

Multidisciplinary Management Approach

• PKD patients with progressive CKD should be managed in a multidisciplinary care setting that includes dietary counseling, education about all RRT modalities, vascular access surgery planning, psychological and social support, and advance care planning discussions, as stated by the American Journal of Kidney Diseases and the Journal of the American Society of Nephrology 2, 4

Conservative Management Option

• Conservative management without dialysis is an appropriate option for patients who choose not to pursue RRT, particularly those with age ≥75 years, multiple comorbidities, frailty, significant functional impairment, cognitive impairment, or limited life expectancy, according to the American Journal of Kidney Diseases and the Journal of the American Society of Nephrology 2, 3, 4

Critical Pitfalls to Avoid

• The American Journal of Kidney Diseases and Praxis Medical Insights recommend not initiating dialysis based solely on GFR level without uremic symptoms present 2, 1
• The American Journal of Kidney Diseases and the Journal of the American Society of Nephrology recommend not offering only one dialysis modality without discussing all options, including transplantation and conservative management 2, 4