OBJECTIVES

Autosomal dominant polycystic kidney disease (ADPKD) involves fluid-filled cysts, progressive total kidney volume and glomerular filtration rate decline to end-stage renal disease (ESRD). 50 to 70% of the ADPKD population requires either renal dialysis or transplant by the 4^th-6^th decade of life. ESRD imposes extreme physiological burden on patients and substantial economic burden on the US healthcare system. The objective of this study was to evaluate the risk difference and crude rate of mortality in ADPKD-ESRD patients on dialysis or after transplant.

METHODS RESULTS

The study population comprised 731 ADPKD-ESRD patients and 53.2% were male (p=0.0034). Mean (SD) age at transplant (60.9 [11.2] years) was greater (p=<0.0001) than dialysis patients (58.4 [12.4] years). Mean (SD) Charlson Comorbidity Index (CCI) score among dialysis patients (3.3 [1.9]) was greater (p=<0.001) than transplant patients (2.7 [1.3]). Ischemic heart (p=<0.001), arrhythmias (p=0.03), chronic pulmonary (p=0.05), peripheral vascular (p=0.01), peptic ulcer (p=<0.001) and rheumatologic diseases (p=<0.001) were more prevalent in dialysis patients. Crude mortality rate per patient year (95% CI) was greater in dialysis patients (7.25% [6.17-8.52]) compared to transplant patients (4.14% [2.36-7.27]) with a risk difference of 3.11%.

CONCLUSIONS

ADPKD-ESRD patients naïve to renal transplant experienced a 57% increased risk of death versus transplant recipients. Further research is needed to determine trends and benefit to risk tradeoffs associated with ADPKD-ESRD patients undergoing renal replacement therapy.