Clinical characteristics of patients with autosomal dominant polycystic kidney disease and risk factors for kidney function decline: a single-center study

Abstract

Background: Autosomal dominant polycystic kidney disease (ADPKD) leads to end-stage renal disease (ESRD) in approximately half of all patients with ADPKD by their sixth decade of life. Factors that cause kidney function decline in these patients are unclear. Methods: This retrospective study included 124 adult patients with ADPKD who were followed up between January 2014 and December 2022. The primary outcome was kidney function decline, which was defined as a decline in the estimated glomerular filtration rate (eGFR) of at least 25% compared with that at baseline. A Cox proportional hazard analysis was performed to identify risk factors for kidney function decline. Results: The median eGFR observation period was 30.0 months (12.0–48.0 months). Forty-eight patients experienced kidney function decline. The univariate Cox proportional hazards analysis indicated that duration ≥ 15 years between the diagnosis and referral to a nephrologist, baseline eGFR level < 57 mL/min/1.73 m2, baseline height-adjusted total kidney volume (htTKV) ≥ 800 mL/m, cyst infection, and proteinuria were associated with the risk of kidney function decline. Multivariate Cox proportional hazards analysis indicated that independent risk factors for kidney function decline were baseline htTKV ≥ 800 mL/m (hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.28–5.97; P = 0.01), cyst infection (HR, 2.54; 95% CI, 1.02–6.34; P = 0.046), and proteinuria (HR, 2.23; 95% CI, 1.22–4.25; P = 0.01). Conclusions: To prevent kidney function decline in patients with ADPKD, cyst growth, cyst infection, and proteinuria should be closely monitored.