Survival after Starting Renal Replacement Treatment in Patients with Autosomal Dominant Polycystic Kidney Disease: A Single-Centre 40-Year Study

Abstract

Background/Aims: 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.