Progression of autosomal dominant kidney disease: measurement of the stage transitions of chronic kidney disease

Article Details

Authors
Christopher M Blanchette, Caihua Liang, Deborah P Lubeck, Britt Newsome, Sandro Rossetti, Xiangmei Gu, Benjamin Gutierrez, Nancy D Lin

Article Type
Original Research

DOI
10.7573/dic.212275

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Abstract

Background: Autosomal dominant polycystic kidney disease (ADPKD) is a progressive genetic disorder characterized by the development of numerous kidney cysts that result in kidney failure. Little is known regarding the key patient characteristics and utilization of healthcare resources for ADPKD patients along the continuum of disease progression. This observational study was designed to describe the characteristics of ADPKD patients and compare them with those of patients with other chronic kidney diseases.

Methods: This retrospective cohort study involved patients with a claim for ADPKD or PKD unspecified from 1/1/2000–2/28/2013 and ≥6 months of previous continuous enrollment (baseline) within a large database of administrative claims in the USA. A random sample of chronic kidney disease (CKD) patients served as comparators. For a subset of ADPKD patients who had only a diagnosis code of unspecified PKD, abstraction of medical records was undertaken to estimate the proportion of patients who had medical chart-confirmed ADPKD. In patients with linked electronic laboratory data, the estimated glomerular filtration rate was calculated via serum creatinine values to determine CKD stage at baseline and during follow-up. Proportions of patients transitioning to another stage and the mean age at transition were calculated.

Results: ADPKD patients were, in general, younger and had fewer physician visits, but had more specific comorbidities at observation start compared with CKD patients. ADPKD patients had a longer time in the milder stages and longer duration before recorded transition to a more severe stage compared with CKD patients. Patients with ADPKD at risk of rapid progression had a shorter time-to-end-stage renal disease than patients with CKD and ADPKD patients not at risk, but stage duration was similar between ADPKD patients at risk and those not at risk.

Conclusions: These results suggest that distribution of patients by age at transition to next stage may be useful for identification of ADPKD patients at risk of rapid progression. The results also suggest that medical claims with diagnosis codes for “unspecified PKD”, in absence of a diagnosis code for autosomal recessive polycystic kidney disease, may be a good proxy for ADPKD.

Keywords: autosomal dominant polycystic kidney disease, ADPKD, chronic kidney disease, serum creatinine, disease stage, end-stage renal disease.

Abbreviations: ADPKD, autosomal dominant polycystic kidney disease; ARPKD, autosomal recessive polycystic kidney disease; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; ESRD, end-stage renal disease; ORD, Optum Research Database; RRT, renal replacement therapy; SCr, serum creatinine; UTIs, urinary-tract infections

Citation
Blanchette CM, Liang C, Lubeck DP, Newsome B, Rossetti S, Gu X, Gutierrez B, Lin ND. Progression of autosomal dominant kidney disease: measurement of the stage transitions of chronic kidney disease. Drugs in Context 2015; 4: 212275. doi: 10.7573/dic.212275

Copyright
Copyright © 2015 Blanchette CM, Liang C, Lubeck DP, Newsome B, Rossetti S, Gu X, Gutierrez B, Lin ND. Distributed under the terms of the Creative Commons Attributions License Deed CC BY NC ND 3.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution
Copyright © 2015 Blanchette CM, Liang C, Lubeck DP, Newsome B, Rossetti S, Gu X, Gutierrez B, Lin ND. http://dx.doi.org/10.7573/dic.212275. Published by Drugs in Context under Creative Commons Attributions License Deed CC BY NC ND 3.0.

Article URL
https://www.drugsincontext.com/progression-of-autosomal-dominant-kidney-disease-measurement-of-the-stage-transitions-of-chronic-kidney-disease

Correspondence
Christopher M Blanchette, PhD, MBA, Associate Dean for Research & Public Engagement, Director of Data Sciences & Business Analytics, Associate Professor of Public Health Sciences, College of Health & Human Services, University of North Carolina at Charlotte, 9201 University City Boulevard, CHHS 476, Charlotte, NC 28223 USA. cblanche@uncc.edu

Provenance
Submitted, externally peer reviewed

Dates
Submitted: 22 December 2014
Accepted, subject to peer review: 5 January 2015
Revised manuscript submitted: 11 March 2015
Publication date: 17 April 2015

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