Mortality risk in patients with autosomal dominant polycystic kidney disease

Deirdre Mladsi; Xiaolei Zhou; Gregory Mader; Myrlene Sanon; Jinyi Wang; Christine Barnett; Cynthia Willey; Stephen Seliger

doi:10.1186/s12882-024-03484-3

Mortality risk in patients with autosomal dominant polycystic kidney disease

BMC Nephrol. 2024 Feb 16;25(1):56. doi: 10.1186/s12882-024-03484-3.

Authors

Deirdre Mladsi¹, Xiaolei Zhou², Gregory Mader², Myrlene Sanon³, Jinyi Wang², Christine Barnett², Cynthia Willey⁴, Stephen Seliger⁵

Affiliations

¹ RTI Health Solutions, Research Triangle Park, NC, USA. dmladsi@rti.org.
² RTI Health Solutions, Research Triangle Park, NC, USA.
³ Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA.
⁴ University of Rhode Island, Kingston, RI, USA.
⁵ University of Maryland School of Medicine, Baltimore, MD, USA.

Abstract

Background: Autosomal dominant polycystic kidney disease (ADPKD) is the leading inheritable cause of end-stage renal disease (ESRD). Mortality data specific to patients with ADPKD is currently lacking; thus, the aim of this study was to estimate mortality in patients with ADPKD.

Methods: We analyzed data from the United States Renal Data System (USRDS) for patients with ADPKD available during the study period of 01/01/2014-12/31/2016, which included a cohort of patients with non-ESRD chronic kidney disease (CKD) and a cohort of patients with ESRD. Mortality rates with 95% confidence intervals (CIs) were calculated overall and by age group, sex, and race for the full dataset and for a subset of patients aged ≥ 65 years. Adjusted mortality hazard ratios (HRs) were calculated using Cox regression modeling by age group, sex, race, and CKD stage (i.e., non-ESRD CKD stages 1-5) or ESRD treatment (i.e., dialysis and transplant).

Results: A total of 1,936 patients with ADPKD and non-ESRD CKD and 37,461 patients with ADPKD and ESRD were included in the analysis. Age-adjusted mortality was 18.4 deaths per 1,000 patient-years in the non-ESRD CKD cohort and 37.4 deaths per 1,000 patient-years in the ESRD cohort. As expected, among the non-ESRD CKD cohort, patients in CKD stages 4 and 5 had a higher risk of death than patients in stage 3 (HR = 1.59 for stage 4 and HR = 2.71 for stage 5). Among the ESRD cohort, patients receiving dialysis were more likely to experience death than patients who received transplant (HR = 2.36). Age-adjusted mortality among patients aged ≥ 65 years in the non-ESRD CKD cohort was highest for Black patients (82.7 deaths per 1,000 patient-years), whereas age-adjusted mortality among patients aged ≥ 65 years in the ESRD cohort was highest for White patients (136.1 deaths per 1,000 patient-years).

Conclusions: Mortality rates specific to patients aged ≥ 65 years suggest racial differences in mortality among these patients in both non-ESRD CKD and ESRD cohorts. These data fill an important knowledge gap in mortality estimates for patients with ADPKD in the United States.

Keywords: Autosomal dominant polycystic kidney disease; End-stage renal disease; Mortality.

MeSH terms

Disease Progression
Humans
Kidney
Kidney Failure, Chronic*
Polycystic Kidney, Autosomal Dominant* / complications
Renal Dialysis / adverse effects
Renal Insufficiency, Chronic* / complications
Renal Insufficiency, Chronic* / therapy
United States / epidemiology