Kidney Failure From Polycystic Disease Linked to Better Outcomes

Patients are more likely to receive a kidney transplant and less likely to die.
Patients are more likely to receive a kidney transplant and less likely to die.

Patients with end-stage renal disease (ESRD) due to autosomal dominant polycystic kidney disease (ADPKD) are more likely than patients with ESRD from other causes to be wait-listed for and to undergo renal transplantation, according to a new study. They also are less likely to die.

Investigators with the U.S. Renal Data System (USRDS), Minneapolis Medical Research Foundation, led by Robert N. Foley, MB, retrospectively analyzed USRDS data from 1,069,343 patients who initiated renal replacement therapy (RRT) from 2001 through 2010. Of these, 23,772 patients had ADPKD as the primary cause of their ESRD and 1,045,571 had a non-ADPKD cause of ESRD. Patients with and without ADPKD were matched according to age, sex, race, and ethnicity to compare clinical outcomes.

During 4.9 years of follow-up, the incidence rate for being listed for kidney transplantation was significantly higher for the ADPKD than the non-ADPKD group (11.7 vs. 8.4 per 100 person-years), as was the incidence rate for receiving a transplant (9.8 vs. 4.8 per 100 person-years), Dr. Foley and colleagues reported online ahead of print in the American Journal of Kidney Diseases. The incidence rate for death was significantly lower for the ADPKD patients (5.6 vs. 15.5 per 100 person-years).

The study also showed that 48% of the ADPKD patients received more than 12 months of nephrology care prior to RRT. “Considering that that ADPKD is a kidney disease for which early detection and access to specialized care should exceed most other types of kidney disease, it was disappointing that less than half the study population had received more than a year of nephrology care before initiating RRT,” the authors wrote.

The investigators observed that ADPKD differs from most other causes of ESRD because it can be detected early in life. “Hence, it has the potential to illuminate issues such as non–disease-specific interventions to prevent ESRD and patterns of nephrology care in late-stage chronic kidney disease.”

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