The Study On The Effect Of Cyst Decortication On The Progression Of Autosomal Dominant Polycystic Kidney Disease In Different Classifications

Objective:Autosomal dominant polycystic kidney disease(ADPKD),as the most common monogenic inherited kidney disease,has an approximate incidence of 1/400 to 1/1000 and is the fourth cause leading to end-stage renal diseases.At present,there is no treatment method available that can prevent ADPKD's progression,and most of treatment methods are merely symptomatic and supportive.The cyst decortication is a domestically and frequently used surgical method to reduce cystsy compression on normal renal parenchyma and protect the renal function.However,whether it can be used to delay the disease progression towards end-stage renal diseases is still controversial.In the last few years,the researchers have found in clinical practices that the effect of surgery differs greatly among patients with ADPKD undergoing cyst decortication.In view of the fact that the quantity of studies on whether the cyst decortication can delay progression is quite limited,and based on the situation that such surgery has been prevalent in the clinical practices of China,we conducted an in-depth study by retrospectively collecting the data of patients with ADPKD from two general hospitals in northern China and made a follow-up for these patients.Using corresponding statistical methods to process the follow-up data,this paper intends to further explore the effect of cyst decortication on the ADPKD 's progression via data analysis,so as to provide a reference for the current treatment of ADPKD in China.Method:In the first phase,the data of 450 cases patients with ADPKD diagnosed from January 2007 to December 2017 were collected.The general and treatment data were collected through the case inquiry and collection system.In the second phase,the rest of their data were followed up in December 2017,involving the absence or presence of follow-up treatment and renal failure,renal failure time,and serum creatinine or glomerular filtration rate when renal failure occurred,and absence or presence of undergoing cyst decortication and the surgery time.In the third phase,after making exclusion according to the study's inclusion and exclusion of criteria,the follow-up data and related information of the remaining 374 patients were uniformly sorted and input.All these cases were divided into surgical group and non-surgical group according to the absence or presence of undergoing cyst decortication and a statistical description of enumeration data and measurement data was performed.Univariate analysis was performed using the log-rank test.The inter-group risks of renal failure were compared.Kaplan-Meier method was used to draw the cumulative hazard curve and calculate the median time without occurrence of renal failure.A univariate Cox proportional hazards model was used to calculate the risk of renal failure in patients with different characteristics.A multivariate Cox stepwise regression model was used to select independent predictors affecting the occurrence of renal failure in patients with ADPKD.Result:A total of 156 cases of patients had a renal failure and the incidence of renal failure was 41.7%.The overall median time without occurrence of renal failure was 17 years(95%CI:14.90-19.10).The median time without occurrence of renal failure in patients undergoing cyst decortication was 20 years(95%CI:18.30-21.70).The median time without renal failure in non-surgical ADPKD patients was 13 years(95%CI:10.06-15.95).Log-Rank test showed that ?2=38.259,P<0.001.Kaplan-Meier analysis showed that surgery was statistically significant.Univariate Cox analysis showed that there was a statistically significant difference in variables of hematuria,ADPKD image classification,and hypertension and so on.In the multivariate Cox proportional hazards model,the variables of image classification,hematuria,hypertension,and cyst decortication were substituted,the results showed that cyst decortication and ADPKD image classification ? were protective factors,but hematuria and hypertension were risk factors.Conclusion:1.The cyst decortication for ADPKD,as a domestically prevalent method for polycystic kidney cysts,may affect the natural process of renal function decline in patients with ADPKD and delay the progression of these patients into renal failure stage.Patients with ADPKD may benefit from this for survival.2.ADPKD image classification ?,compared to classification ?,may be a protective factor for the kidney failure secondary to ADPKD.Hematuria and hypertension,as common complications in patients with ADPKD,may be risk factors.