Survival after Starting Renal Replacement Treatment in Patients with Autosomal Dominant Polycystic Kidney Disease: A Single-Centre 40-Year Study

Abstract

Background/Aims: Adult polycystic kidney disease (ADPKD) has a predictable natural history and the relative lack of co-morbidity allows a relatively unconfounded assessment of survival. We examined whether survival on renal replacement treatment (RRT) has improved over the last four decades compared to that in the general population. Methods: We conducted a retrospective cohort study of all patients with ADPKD who received RRT between 1971 and 2000 at the Oxford Kidney Unit. The main exposure was period of start of treatment (1971–1985 vs. 1986–2000) and the key outcome was overall survival. Standard Cox regression techniques were used to assess the association between these baseline variables and survival. Results: Age at start of RRT (HR per 1 year 1.08; 95% CI 1.06–1.10) and presence of a functioning transplant (HR 0.22; 95% CI 0.16–0.31) were associated with improved survival in unadjusted analyses. After adjustment for age the period of treatment also became a significant predictor of overall survival (HR 0.67; 95% CI 0.47–0.97). Conclusions: Survival on RRT appears to have improved and exceeds that observed in the general population, such that RRT now provides almost two-thirds of the life expectancy of the general population, compared to about half in earlier decades.

Renal replacement therapy in ADPKD patients: a 25-year survey based on the Catalan registry

“…Various articles have shown higher survival of ADPKD patients on RRT as compared to non-ADPKD patients, which concurs with our data [46,47]. We found no differences as to the age of death, even though ADPKD patients started RRT earlier than non-ADPKD patients; this indicates a longer survival of ADPKD patients on RRT.…”

Comparative Study of Outcomes among Patients with Polycystic Kidney Disease on Hemodialysis and Peritoneal Dialysis

“…There are numerous studies addressing survival after renal replacement therapy in patients with PCKD 4 6 8 9 10 11 , however, the observation of outcomes between dialysis modalities were unavoidably subject to selection bias. This is the first study aimed to compare survival, hospitalization risk and medical expenditure of patients with PCKD on PD and HD.…”

“…Healthier and younger patients with PCKD tended to choose PD, whereas those with hypertension, heart disease, or cerebral vascular disease were less likely to select PD ( Table 1 ). Therefore, it is not surprising that the statistical results without adequately adjusting for self-selection showed a better outcome and higher chance of kidney transplantation for the PD patients 3 4 6 10 11 . In PS-matched analysis, the patients with PCKD on HD did not have a higher risk of overall mortality, regardless of the age group or incident era of dialysis.…”

“…PCKD accounts for 8 to 10% of ESRD patients in Western countries 3 4 , and costs for its treatment have been reported to exceed 1.5 billion euro a year 4 . Despite multiple extra-renal complications, patients with PCKD have more favorable outcomes after ESRD compared with their counterparts with other causes of kidney failure 5 6 .…”

“…The clinical diagnosis for PCKD usually relies on examination of family history and imaging studies. As PCKD is a relatively rare disease with a slow progression, it is expected that a study on this disease in a single center would only be able to enroll a small number of patients 6 8 9 . Using healthcare administrative data to conduct research on PCKD would therefore be a preferable, economical approach, which could also provide highly reliable information on the prognosis and treatment effects regarding PCKD 5 10 11 12 .…”