title: ESRD from autosomal dominant polycystic kidney disease in the United States, 2001-2010.
abstract: BACKGROUND
  Autosomal dominant polycystic kidney disease (ADPKD) is amenable to early detection and specialty care. Thus, while important to patients with the condition, end-stage renal disease (ESRD) from ADPKD also may be an indicator of the overall state of nephrology care.
  
  
  METHODS
  Retrospective cohort study of temporal trends in ESRD from ADPKD and pre-renal replacement therapy (RRT) nephrologist care, 2001-2010 (n = 23,772).
  
  
  METHODS
  US patients who initiated maintenance RRT from 2001 through 2010 (n = 1,069,343) from US Renal Data System data.
  
  
  METHODS
  ESRD from ADPKD versus from other causes for baseline characteristics and clinical outcomes; interval 2001-2005 versus 2006-2010 for comparisons of cohort of patients with ESRD from ADPKD.
  
  
  RESULTS
  Death, wait-listing for kidney transplant, kidney transplantation.
  
  
  METHODS
  US census data were used as population denominators. Poisson distribution was used to compute incidence rates (IRs). Incidence ratios were standardized to rates in 2001-2002 for age, sex, and race/ethnicity. Patients with and without ADPKD were matched to compare clinical outcomes. Poisson regression was used to calculate IRs and adjusted HRs for clinical events after inception of RRT.
  
  
  RESULTS
  General population incidence ratios in 2009-2010 were unchanged from 2001-2002 (incidence ratio, 1.02). Of patients with ADPKD, 48.1% received more than 12 months of nephrology care before RRT; preemptive transplantation was the initial RRT in 14.3% and fistula was the initial hemodialysis access in 35.8%. During 4.9 years of follow-up, patients with ADPKD were more likely to be listed for transplantation (IR, 11.7 [95% CI, 11.5-12.0] vs 8.4 [95% CI, 8.2-8.7] per 100 person-years) and to undergo transplantation (IR, 9.8 [95% CI, 9.5-10.0] vs 4.8 [95% CI, 4.7-5.0] per 100 person-years) and less likely to die (IR, 5.6 [95% CI, 5.4-5.7] vs 15.5 [95% CI, 15.3-15.8] per 100 person-years) than matched controls without ADPKD.
  
  
  CONCLUSIONS
  Retrospective nonexperimental registry-based study of associations; cause-and-effect relationships cannot be determined.
  
  
  CONCLUSIONS
  Although outcomes on dialysis therapy are better for patients with ADPKD than for those without ADPKD, access to predialysis nephrology care and nondeclining ESRD rates may be a cause for concern.
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN; United States Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: Scott
authors.initials: S
authors.lastname: Reule
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN; United States Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: Donal J
authors.initials: DJ
authors.lastname: Sexton
authors.affiliation: United States Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Solid
authors.affiliation: United States Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: Shu-Cheng
authors.initials: SC
authors.lastname: Chen
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN; United States Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Collins
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN; United States Renal Data System, Minneapolis Medical Research Foundation, Minneapolis, MN. Electronic address: rfoley@cdrg.org.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Foley
mesh_terms: D000328:Adult; D000368:Aged; D042241:Early Diagnosis; D005006:Ethnicity; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management / Q000458:organization & administration / Q000706:statistics & numerical data; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011785:Quality Assurance, Health Care; D012042:Registries; D017582:Renal Replacement Therapy / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: Dialysis; autosomal dominant polycystic kidney disease (ADPKD); clinical outcome; end-stage renal disease (ESRD); incidence; registry data; renal replacement therapy (RRT); renal transplant