Racial Differences in ADPKD Mortality for Older Adults

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A large analysis of patients with autosomal-dominant polycystic kidney disease (ADPKD) finds differences in mortality risk for Black versus White patients aged 65 years or older, reports a study in BMC Nephrology.

The researchers analyzed US Renal Data System data for patients with ADPKD from 2014 through 2016. The analysis included a cohort of 1936 patients with non-end stage renal disease (ESRD) chronic kidney disease (CKD) and a cohort of 37,461 patients with ESRD. The mean age was 71.4 years in the cohort with non-ESRD CKD and age 59.2 years in the cohort with ESRD. Race was classified as White in 79.6% and 73.8%, respectively.

After adjustment for age, mortality was 18.4 per 1000 patient-years in patients with ADPKD with non-ESRD CKD and 37.4 per 1000 patient-years for those with ADPKD and ESRD. On Cox regression modeling in the cohort with non-ESRD CKD, risk of death was higher for patients with more advanced disease: hazard ratio (HR), 1.59 for stage 4 and 2.71 for stage 5 CKD compared with stage 3. In the cohort with ESRD, risk of death was more than twice as high among patients undergoing dialysis: HR, 2.36.

Among patients with non-ESRD CKD aged 65 years or older, age-adjusted mortality was highest for Black patients: 82.7 deaths per 1000 patient-years. In contrast, among older adults in the cohort with ESRD, mortality was highest for White patients: 136.1 deaths per 1000 patient-years.

The study revealed findings regarding mortality specific to patients with ADPKD, the leading inherited cause of ESRD. For patients aged 65 or older with ADPKD and ESRD, the data show a “numerically lower” mortality compared with previous reports, possibly reflecting “more effective treatment and disease management.”

In the same age group, the findings suggest racial differences in both cohorts of non-ESRD CKD and ESRD of patients with ADPKD, with a possible survivorship effect among Black patients. “Black patients may be less likely than other racial groups to survive long enough to reach ESRD, perhaps because of inequities in care,” the researchers write. “ADPKD also may be underdiagnosed in Black patients with a hypertension comorbidity” [Mladsi D, et al. Mortality risk in patients with autosomal dominant polycystic kidney disease. BMC Nephrol 2024; 25:56. doi: 10.1186/s12882-024-03484-3].