Vascular Access Outcomes in Patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD).

Abstract

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a leading hereditary cause of end-stage kidney disease (ESKD), often utilising hemodialysis as a form of kidney replacement therapy. Patients with ADPKD may also present with extrarenal manifestations, including arterial aneurysms. The gold standard for hemodialysis access is an arteriovenous vascular access (VA), such fistulas (AVFs) or grafts (AVGs). However, limitations, such as low VA flow and inadequate AVF outward remodelling, impact VA utilization. This study aimed to explore whether ADPKD impacts patency rates of AVFs/AVGs in comparison to other underlying ESKD causes. We conducted a retrospective cohort study using data from the Swedish Renal Registry from 2011 to 2020, with follow-up until 2022. We included 496 ADPKD patients and 4321 propensity-score matched controls. VA patency rates of ADPKD patients were compared to those of non-ADPKD patients using Kaplan-Meier survival curves and the Mantel-Cox log-rank test. Interventions to maintain or restore patency were also analysed. Patients with ADPKD constituted 8.0% of all patients, with a higher proportion in the pre-ESKD phase during VA creation (51.6% vs. 40.6%). No significant differences were observed in primary, post-cannulation primary, secondary, or functional patency between ADPKD and non-ADPKD patients. However, more VAs were ligated in ADPKD patients (10.5% vs. 7.7%, p=0.03), and they underwent more first interventions to re-establish flow (49.4% vs. 41.9%, p=0.02). These findings suggest that AVF/AVG patency remains comparable in ESKD patients with or without ADPKD, and vascular access monitoring and treatment strategies for ADPKD patients should align with those for individuals with other ESKD causes.