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Kidney Week

Abstract: PO1258

Polycystic Kidney Disease and Race

Session Information

Category: Genetic Diseases of the Kidneys

  • 1001 Genetic Diseases of the Kidneys: Cystic

Authors

  • Hayward, Alexandra, University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
  • McGill, Rita L., University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
  • Saunders, Milda Renne, University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
  • Chapman, Arlene B., University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
Background

Racial/ethnic differences in the development of kidney failure (ESKD) and transplant (TX) access are well-documented. ESKD is anticipated in familial autosomal dominant polycystic kidney disease (ADPKD), providing the opportunity for greater ESKD preparation. We sought to define the impact of race on ESKD/TX outcomes in ADPKD.

Methods

White (W), African-American (A), or Hispanic (H) ADPKD patients were identified in USRDS 1/2000-6/2018; demographic and laboratory data were obtained. Median income was derived from US Census. Models included: age at ESKD (linear), pre-emptive TX (logistic), and TX after dialysis initiation (Cox), adjusted for age, sex, albumin, hemoglobin, eGFR, insurance, income, ESKD Network, and employment, with W as referent.

Results

Among 41,485 patients, (77.3% W, 13.3% A, 9.4% H), characteristics/outcomes are shown in Table 1. AA and H had lower median income and less private insurance, pre-ESKD nephrology care, and employment. For AA and H, peritoneal dialysis and TX were less common than in W. Albumin, hemoglobin, and GFR were lowest in A.
ESKD occurred 2.2 ± 0.2 and 4.8 ± 0.3 years earlier in A and H, compared to W. Adjusted odds of pre-emptive TX were 0.38(0.33, 0.42) and 0.47(0.40, 0.55) for A and H. Adjusted hazards for TX after dialysis initiation were 0.60(0.55, 0.65) for A and 0.78(0.72, 0.85, for H, P<0.001 for all. TX rates for A vs W by network are shown in Figure 1.

Conclusion

Despite the hereditary nature of ADPKD, renal outcomes differ by race, attributed to in part, economic and geographic factors. Health inequity is a contributing factor to patient outcomes in ADPKD that needs to be addressed.