Analysis of data from the ERA-EDTA Registry indicates that conventional treatments for chronic kidney disease do not reduce the need for renal replacement therapy in autosomal dominant polycystic kidney disease.
Autosomal dominant polycystic kidney disease (ADPKD) is a major cause of end-stage kidney failure, but is often identified early and therefore amenable to timely treatment. Interventions known to postpone the need for renal replacement therapy (RRT) in non-ADPKD patients have also been tested in ADPKD patients, but with inconclusive results. To help resolve this we determined changes in RRT incidence rates as an indicator for increasing effective renoprotection over time in ADPKD. We analyzed data from the European Renal Association-European Dialyses and Transplant Association Registry on 315,444 patients starting RRT in 12 European countries between 1991 and 2010, grouped into four 5-year periods. Of them, 20,596 were due to ADPKD. Between the first and last period the mean age at onset of RRT increased from 56.6 to 58.0 years. The age- and gender-adjusted incidence rate of RRT for ADPKD increased slightly over the four periods from 7.6 to 8.3 per million population. No change over time was found in the incidence of RRT for ADPKD up to age 50, whereas in recent time periods the incidence in patients above the age of 70 clearly increased. Among countries there was a significant positive association between RRT take-on rates for non-ADPKD kidney disease and ADPKD. Thus, the increased age at onset of RRT is most likely due to an increased access for elderly ADPKD patients or lower competing risk prior to the start of RRT rather than the consequence of effective emerging renoprotective treatments for ADPKD.
Department of Nephrology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
Edwin M
EM
Spithoven
ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Anneke
A
Kramer
Department of Nephrology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
Esther
E
Meijer
Division of Nephrology, Copenhagen University Hospital, Roskilde, Denmark.
Bjarne
B
Orskov
Division of Nephrology, University Clinic, University of Würzburg, Würzburg, Germany.
Christoph
C
Wanner
Richard Bright Renal Unit, Bristol, UK.
Fergus
F
Caskey
French-Speaking Belgium ESRD Registry, Bruxelles, Belgium.
Frederic
F
Collart
Finnish Registry of Kidney Diseases, Helsinki, Finland.
Patrik
P
Finne
1] UK Renal Registry, Southmead Hospital, Bristol, UK [2] Regional Nephrology Unit, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK.
Damian G
DG
Fogarty
Department of Paediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Jaap W
JW
Groothoff
Department of Nephrology, Radboud University Nijmegen, Medical Centre, Leiden, The Netherlands.
Andries
A
Hoitsma
Nephrology, Dialysis, Transplantation Department, University Hospital of Rangueil, Toulouse, France.
Marie-Béatrice
MB
Nogier
U.O.C. Nefrologia, Dialisi e Trapianto, Azienda Ospedaliera di Reggio Calabria and CNR-IBIM, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy.
Maurizio
M
Postorino
Department of Medicine and Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
Pietro
P
Ravani
1] Subirección General de Epidemiología y Vigilancia de la Salud. Conselleria de Sanitat. Generalitat C, Valenciana, Spain [2] Spanish Consortium of Epidemiology and Public Health Research (CIBERESP).
Oscar
O
Zurriaga
ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Kitty J
KJ
Jager
Department of Nephrology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
Ron T
RT
Gansevoort
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005060:Europe; D005260:Female; D060730:Glomerular Filtration Barrier; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D016891:Polycystic Kidney, Autosomal Dominant / Q000503:physiopathology / Q000628:therapy*; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology / Q000628:therapy*; D017582:Renal Replacement Therapy / Q000639:trends*; D012737:Sex Factors; D055815:Young Adult