ADPKD Patients with Advanced CKD at Increased Risk of Adverse Outcomes

New Orleans—Patients with autosomal dominant polycystic kidney disease (ADPKD) develop progressive chronic kidney disease (CKD) and a subsequent increased risk for adverse events that include cardiovascular disease, infections, end-stage renal disease (ESRD), and mortality. There are few data available on the risks of adverse events in patients with ADPKD and advanced CKD.

Manish M. Sood, MD, and colleagues conducted a study designed to identify the risks of CKD-related adverse outcomes in patients with ADPKD compared with patients without ADPKD. They reported results of the study during a poster session at Kidney Week 2017 in a poster titled The Risk of Adverse Events in Polycystic Kidney Disease Patients with Advanced CKD.

The researchers utilized data from the CanPREDDICT (Canadian Study of Prediction of Death, Dialysis, and Interim Cardiovascular Events) cohort, a prospective pan-Canadian cohort study conducted from 2008 to 2013 in 28 facilities caring for patients with advanced CKD (defined as estimated glomerular filtration rate (eGFR) 15-45 mL/min/1.73 m2) with adjudicated outcomes.

Cox proportional hazards and Fine and Gray models were used to assess the risk of cardiovascular disease, including coronary artery disease or congestive heart failure; infection; ESRD; or all-cause mortality in a propensity-score matched (4:1) cohort of non-ADPKD and ADPKD patients.

Of a total of 2370 patients, 105 with ADPKD were matched with 416 without ADPKD. At baseline mean age was 62.6 years and eGFR was 27.8 mL/min/1.73m2. Median follow-up was 3.8 years (1680 person-years of follow time), there were a total of 43 cardiovascular, 83 ESRD, 117 infectious, and 39 all-cause mortality events.

There was an association between ADPKD and a higher risk of cardiovascular events (9.5% vs 7.9%, hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.04-2.04), and ESRD (25.7% vs 13.5%; HR, 2.00; 95% CI, 1.33-3.01), and with similar risk for infection (21.9% vs 22.6%; HR, 1.16; 95% CI, 0.75-1.82) or all-cause mortality (6.7% vs 7.7%; HR, 0.87; 95% CI, 0.40-1.91) compared with non-ADPKD. Types of infections (urinary, respiratory, hematologic, or other) were similar between the two groups.

“ADPKD patients with advanced CKD are at higher risk of ESRD and cardiovascular events compared with non-ADPKD patients. These findings suggest that judicious monitoring, screening, and treatment for adverse outcomes in ADPKD patients, especially related to cardiovascular disease, may be beneficial,” the researchers said.

Source: Sood MM, De chickera SN, Levin A, Tang M, Akbari A. The risk of adverse events in polycystic kidney patients with advanced CKD. Abstract of a poster presented at the American Society of Nephrology 2017 Kidney Week, November 3, 2017, New Orleans, Louisiana