Vincent Nino Apelin
National Kidney and Transplant Institute, Philippines
Title: Survival and Analysis of Risk Factors of Mortality Among Adult Filipino Patients with Polycystic Kidney Disease on Renal Replacement Therapy: A Single Center, Retrospective Cohort Study
Biography
Biography: Vincent Nino Apelin
Abstract
Background: Risk of mortality among patients with Polycystic Kidney Disease is higher compared with the general population. There is paucity of data with regards to incidence, risk factors and causes of mortality among Filipino Polycystic Kidney Disease patients initiated on renal replacement therapy (RRT)
Aim: To determine the risk factors of death among patients with Adult Polycystic Kidney Disease on RRT
Methods: A retrospective cohort of polycystic kidney disease patients from 2010 to 2018 was reviewed. Survival probabilities were estimated using the Kaplan-Meier method. Backward stepwise Cox regression analysis was used to determine overall mortality and early mortality.
Results: Included in the analysis were 138 PKD patients with a mean age of 55, 52% were female and 93% on hemodialysis. The most frequent renal manifestation is proteinuria while polycystic liver disease is the most common extrarenal manifestation. Slightly over half (51%) of patients have been diagnosed with PKD for more than 5 years.
There were 32 recorded deaths, with 59% as outcome of infection. Cumulative incidence of mortality was 45% after 5 years. After adjusting for all risk factors intracranial aneurysm is a strong independent risk factor for overall and early mortality. Proteinuria as a renal manifestation is associated with less hazard for mortality. Patients with concomitant polycystic liver disease are twice as likely to die compared to those without (aHR2.593, 95% CI 1.08-6.22, p = 0.033). Higher albumin levels are associated with decreased hazard for mortality (aHR 0.558, 95% CI 0.36-0.85).
Conclusion: Death occurred in 20% of PKD patients initiated on RRT with more than half of patients died due to infection. The cumulative incidence of mortality is 48% at 5 years. Intracranial aneurysm as an extrarenal manifestation, is a strong independent predictor of overall mortality and early mortality. Proteinuria as a renal manifestation is associated with less hazard for mortality. Patients with concomitant polycystic liver disease are twice as likely to die while higher albumin levels are associated with decreased hazard for mortality.