Survival after starting renal replacement treatment in patients with autosomal dominant polycystic kidney disease: a single-centre 40-year study.
OBJECTIVE
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.
Oxford Kidney Unit, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK. richard.haynes@ouh.nhs.uk
Richard
R
Haynes
Farhad
F
Kheradmand
Christopher G
CG
Winearls
D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D016572:Cyclosporine / Q000627:therapeutic use; D004739:England / Q000453:epidemiology; D005260:Female; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality / Q000628:therapy; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016016:Proportional Hazards Models; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate
D006397:Hematinics; D007166:Immunosuppressive Agents; D016572:Cyclosporine