ESRD from autosomal dominant polycystic kidney disease in the United States, 2001-2010

Abstract

Background: Autosomal dominant polycystic kidney disease (ADPKD) is amenable to early detection and specialty care. Thus, while important to patients with the condition, end-stage renal disease (ESRD) from ADPKD also may be an indicator of the overall state of nephrology care.

Study design: Retrospective cohort study of temporal trends in ESRD from ADPKD and pre-renal replacement therapy (RRT) nephrologist care, 2001-2010 (n = 23,772).

Setting & participants: US patients who initiated maintenance RRT from 2001 through 2010 (n = 1,069,343) from US Renal Data System data.

Predictor: ESRD from ADPKD versus from other causes for baseline characteristics and clinical outcomes; interval 2001-2005 versus 2006-2010 for comparisons of cohort of patients with ESRD from ADPKD.

Outcomes: Death, wait-listing for kidney transplant, kidney transplantation.

Measurements: US census data were used as population denominators. Poisson distribution was used to compute incidence rates (IRs). Incidence ratios were standardized to rates in 2001-2002 for age, sex, and race/ethnicity. Patients with and without ADPKD were matched to compare clinical outcomes. Poisson regression was used to calculate IRs and adjusted HRs for clinical events after inception of RRT.

Results: General population incidence ratios in 2009-2010 were unchanged from 2001-2002 (incidence ratio, 1.02). Of patients with ADPKD, 48.1% received more than 12 months of nephrology care before RRT; preemptive transplantation was the initial RRT in 14.3% and fistula was the initial hemodialysis access in 35.8%. During 4.9 years of follow-up, patients with ADPKD were more likely to be listed for transplantation (IR, 11.7 [95% CI, 11.5-12.0] vs 8.4 [95% CI, 8.2-8.7] per 100 person-years) and to undergo transplantation (IR, 9.8 [95% CI, 9.5-10.0] vs 4.8 [95% CI, 4.7-5.0] per 100 person-years) and less likely to die (IR, 5.6 [95% CI, 5.4-5.7] vs 15.5 [95% CI, 15.3-15.8] per 100 person-years) than matched controls without ADPKD.

Limitations: Retrospective nonexperimental registry-based study of associations; cause-and-effect relationships cannot be determined.

Conclusions: Although outcomes on dialysis therapy are better for patients with ADPKD than for those without ADPKD, access to predialysis nephrology care and nondeclining ESRD rates may be a cause for concern.

Keywords: Dialysis; autosomal dominant polycystic kidney disease (ADPKD); clinical outcome; end-stage renal disease (ESRD); incidence; registry data; renal replacement therapy (RRT); renal transplant.

Figure 1

Rates of death, listing for renal transplant, and transplant in patients with ADPKD (n = 23,619, 99.4% of the ADPKD cohort) and an equal number of matched control patients without ADPKD. Controls were matched by age, sex, and race at initiation of renal replacement therapy. Parameters shown are rates per 100 person-years, with error bars showing 95% confidence intervals. A formal tabulation of numerical estimates appears in Supplemental Table S1. ADPKD, autosomal dominant polycystic kidney disease.