Kidney Week

Abstract: FR-PO511

The Risk of Adverse Events in Polycystic Kidney Disease Patients with Advanced CKD

Session Information

• CKD: Epidemiology, Outcomes - Non-Cardiovascular - I
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Chronic Kidney Disease (Non-Dialysis)

• 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular

Authors

• Sood, Manish M., Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

Manish M. Sood,

• De chickera, Sonali Natasha, The Ottawa Hospital - University of Ottawa, Ottawa, Ontario, Canada

Sonali Natasha De chickera,

• Levin, Adeera, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada

Adeera Levin,

• Tang, Mila, St. Paul's Hospital, Vancouver, Alberta, Canada

Mila Tang,

• Akbari, Ayub, University of Ottawa, Ottawa, Ontario, Canada

Ayub Akbari,

Background

Autosomal dominant polycystic kidney disease (ADPKD) leads to progressive chronic kidney disease (CKD) with a subsequent increasing risk of adverse events such as cardiovascular disease (CV), infections, end-stage kidney disease (ESKD) and mortality. To date limited information exists regarding the risks of adverse events in ADPKD patients with advanced CKD. The objective of this study was to determine the risks of CKD-related adverse outcomes in ADPKD patients compared to non-ADPKD patients.

Methods

We examined data from the Canadian Study of Prediction of Death, Dialysis and Interim Cardiovascular Events (CanPREDDICT) cohort. CanPREDDICT was a prospective pan-Canadian cohort study from 2008-2013 involving 28 facilities caring for patients with advanced CKD (eGFR=15-45 ml/min/1.73m²) with adjudicated outcomes. We used Cox proportional hazards and Fine and Gray models to examine the risk of CV (defined as coronary artery disease or CHF), infection, ESKD, or all-cause mortality in a propensity-score matched (4:1) cohort of non-ADPKD and ADPKD patients.

Results

Among a total of 2,370 patients, 105 with ADPKD were matched with 416 non-ADPKD patients with a baseline mean age and eGFR of 62.6 (SD 14.0) years and 27.8 (SD 9.0) mls/min/1.73m², respectively. During a total of 1,680 person-years of follow time (median follow-up 3.8 years), there were a total of 43 CV, 83 ESKD, 117 infectious and 39 all-cause mortality events. ADPKD was associated with a higher risk of cardiovascular events (9.5% vs. 7.9%, HR 1.46 95%CI 1.04-2.04) and ESKD (25.7% vs 13.5%, HR 2.00 95%CI 1.33-3.01), and with similar risks for infection (21.9% vs 22.6%, HR 1.16 95%CI 0.75-1.82) or all-cause mortality (6.7% vs 7.7%, HR 0.87 95%CI 0.40-1.91) compared to non-ADPKD. There were no differences in the types of infections (urinary, respiratory, hematologic or other) between the two groups (p=0.585).

Conclusion

ADPKD patients with advanced CKD are at higher risk of ESKD and cardiovascular events compared to non-ADPKD patients. These findings suggest that judicious monitoring, screening and treatment for adverse outcomes in ADPKD patients, especially related to cardiovascular disease, may be beneficial.