B- CRF : measurement of renal function
C-04 : Polycystic kidney disease
F- 05 : conventional hemodialysis
J- 02 : European guidelines
Analysis of data from the ERA-EDTA Registry indicates that conventional treatments
for chronic kidney disease do not reduce the need for renal replacement therapy in
autosomal dominant polycystic kidney disease
Edwin M Spithoven1,18, Anneke Kramer2,18, Esther Meijer1, Bjarne Orskov3, Christoph
Wanner4, Fergus Caskey5, Frederic Collart6, Patrik Finne7, Damian G Fogarty8,9, Jaap W
Groothoff10, Andries Hoitsma11, Marie-Béatrice Nogier12, Maurizio Postorino13, Pietro
Ravani14, Oscar Zurriaga15,16, Kitty J Jager2, Ron T Gansevoort1, on behalf of the ERAEDTA Registry*, EuroCYST Consortium* and the WGIKD*17
1 Department of Nephrology, University Medical Center Groningen (UMCG), University of
Groningen, Groningen, The Netherlands
2 ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center,
University of Amsterdam, Amsterdam, The Netherlands
3 Division of Nephrology, Copenhagen University Hospital, Roskilde, Denmark
4 Division of Nephrology, University Clinic, University of Würzburg, Würzburg, Germany
5 Richard Bright Renal Unit, Bristol, UK
6 French-Speaking Belgium ESRD Registry, Bruxelles, Belgium
7 Finnish Registry of Kidney Diseases, Helsinki, Finland
8 UK Renal Registry, Southmead Hospital, Bristol, UK
9 Regional Nephrology Unit, Belfast Health and Social Care Trust, Belfast, Northern
Ireland, UK
10 Department of Paediatric Nephrology, Emma Children’s Hospital, Academic Medical
Center, Amsterdam, The Netherlands
11 Department of Nephrology, Radboud University Nijmegen, Medical Centre, Leiden, The
Netherlands
12 Nephrology, Dialysis, Transplantation Department, University Hospital of Rangueil,
Toulouse, France
13 U.O.C. Nefrologia, Dialisi e Trapianto, Azienda Ospedaliera di Reggio Calabria and
CNR-IBIM, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension,
Reggio Calabria, Italy
14 Department of Medicine and Faculty of Medicine, University of Calgary, Calgary,
Alberta, Canada
15 Subirección General de Epidemiología y Vigilancia de la Salud. Conselleria de Sanitat.
Generalitat C, Valenciana, Spain
16 Spanish Consortium of Epidemiology and Public Health Research (CIBERESP)
Correspondence: Ron T. Gansevoort, Department of Nephrology, University Medical Center
Groningen (UMCG), University of Groningen, PO Box 30.001, 9700 RB Groningen, The
Netherlands. E-mail: R.T.Gansevoort@umcg.nl
Journal : Kidney International
Year : 2014
Volume : 86
Pages : 1244–1252
ABSTRACT
Autosomal dominant polycystic kidney disease (ADPKD) is a major cause of end-stage
kidney failure, but is often identified early and therefore amenable to timely treatment.
Interventions known to postpone the need for renal replacement therapy (RRT) in nonADPKD patients have also been tested in ADPKD patients, but with inconclusive results. To
help resolve this we determined changes in RRT incidence rates as an indicator for
increasing effective renoprotection over time in ADPKD. We analyzed data from the
European Renal Association-European Dialyses and Transplant Association Registry on
315,444 patients starting RRT in 12 European countries between 1991 and 2010, grouped
into four 5-year periods. Of them, 20,596 were due to ADPKD. Between the first and last
period the mean age at onset of RRT increased from 56.6 to 58.0 years. The age- and
gender-adjusted incidence rate of RRT for ADPKD increased slightly over the four periods
from 7.6 to 8.3 per million population. No change over time was found in the incidence of
RRT for ADPKD up to age 50, whereas in recent time periods the incidence in patients
above the age of 70 clearly increased. Among countries there was a significant positive
association between RRT take-on rates for non-ADPKD kidney disease and ADPKD. Thus,
the increased age at onset of RRT is most likely due to an increased access for elderly
ADPKD patients or lower competing risk prior to the start of RRT rather than the
consequence of effective emerging renoprotective treatments for ADPKD.
Keywords: ADPKD; epidemiology; renoprotective therapy
COMMENTS
Autosomal dominant polycystic kidney disease (ADPKD) is the most common heritable
kidney disease, affecting ~1 in every 1000 subjects Most affected subjects show progressive
renal function decline and need renal replacement therapy (RRT) between their 40th and
70th year of age.
Over the past decades several treatment options have emerged to postpone the need for
RRT in subjects with chronic kidney disease, such as strict blood pressure control, renin–
angiotensin–aldosterone system inhibition, and low-protein diets.
The hypothesis of this study was that, with a stable prevalence of ADPKD in the general
population, changes in the incidence rate of RRT may provide indications whether
renoprotective treatments have emerged for ADPKD during the last two decades.
Between 1991 and 2010 a total of 314,176 patients from 12 countries started RRT; of them,
20,483 had ADPKD as the cause of kidney failure and 293,693 patients had other kidney
diseases. An overall 54% of ADPKD patients and 62% of non-ADPKD patients were male.
Over this time period the crude incidence rate of RRT for ADPKD increased from 6.9 to 8.4
per million population (p.m.p.). The average age- and gender-adjusted incidence rate has
increased by 9.2% from 7.6 p.m.p. in 1991–1995 to 8.3 p.m.p. in 2006–2010
This study shows that the incidence rate of RRT and the age at onset of RRT for ADPKD
have increased slightly. Importantly, for ADPKD patients up to 50 years of age the RRT
incidence rate expressed per million of the age-related population has remained stable,
whereas at older age an increase was observed. Furthermore, a positive association was
found between the RRT incidence rate for ADPKD and that for non-ADPKD patients.
The authors interpret these findings as being due to more number of elderly patients having
been selected to start RRT or to a decrease in mortality of older patients before reaching
ESRD rather than as effective renoprotective treatments having emerged for ADPKD.
However this retrospective study has not evaluated the present ongoing studies dealing with
treatments such as ligands of the AVP receptor or sirolimus prescribed for postponing endstage renal failure and the start of dialysis in patients with PKD.
Pr. Jacques CHANARD
Professor of Nephrology