Back
Autosomal dominant polycystic kidney disease (ADPKD) is a multisystem syndrome associated with kidney failure and cardiovascular disease. Cardiovascular disease is a major cause of morbidity and mortality in patients receiving kidney replacement therapy (KRT). We sought to evaluate cardiovascular disease, morbidity and mortality in Australian and New Zealand patients with ADPKD commencing KRT.
We conducted a retrospective review of all patients with kidney failure over 18 years commencing KRT between 1963 and 2020, stratified across eras, using Australia and New Zealand Transplant (ANZDATA) Registry data. Outcomes of interest were morbidity burden including cardiovascular disease, mortality and death-censored graft survival, comparing people with ADPKD to those with other causes of kidney failure (non-ADPKD), with competing risk analysis for graft survival.
A total of 63875 patients commenced KRT during the study period, of whom 3.9% had ADPKD. Comorbidities at initiation of KRT were generally less common in people with ADPKD compared with those with non-ADPKD: chronic lung disease (9.9% vs 15.3%), coronary artery disease (25.8% vs 38.3%), peripheral vascular disease (8.1% vs 22.1%), cancer (13.4% vs 16.2%) and diabetes (11.6% vs 54.4%), although the frequency of cerebrovascular disease was similar (11.4% vs 13.1%). ADPKD was associated with a possibly higher risk of mortality compared non-ADPKD (adjusted hazard ratio [aHR],1.016; 95% CI 1.016-1.017, p < 0.001), unlikely to be clinically relevant. Factors associated with mortality included age, gender, ethnicity, body mass index, smoking status, chronic lung disease, coronary artery disease, peripheral vascular disease, cerebrovascular disease, diabetes, cancer, dialysis modality and dialysis vintage. Causes of death were similar between the two groups with respect to cardiovascular (27.5% vs 27.6%), infection (7.9% vs 8.5%) and cancer (3.4% vs 3.5%) causes. Kidney transplant recipients had a lower frequency of comorbidities in both cohorts, with a similar incidence of coronary artery disease in both groups (ADPKD 7.2% vs non ADPKD 8.0%). ADPKD was associated with a slightly higher risk of mortality in kidney transplant recipients (aHR, 1.052; 95% CI 1.050-1.055, p < 0.001). Factors associated with mortality included age, smoking status, chronic lung disease, coronary artery disease, peripheral vascular disease, cerebrovascular disease, diabetes, cancer, prior peritoneal dialysis and donor age. ADPKD was marginally associated with graft failure (aHR, 1.005; 95% CI 1.002-1.007, p < 0.001), unlikely to be clinically meaningful.
Compared with patients with other forms of kidney failure, patients with ADPKD commence KRT with fewer medical comorbidities with clinically similar mortality outcomes.