Acquired cystic kidney disease: occurrence, prevalence, and renal cancers

Acquired cystic kidney disease (ACKD) is the result of cyst formation in the failing kidney. It has become more common because of increases in retention of the patients' own kidneys, growth in the dialysis population, and survival of long-term dialysis patients. We studied our chronic dialysis population for ACKD and renal cancers, and conducted a literature review of ACKD and renal cancer. We analyzed our chronic dialysis patients from 1979 through 1989 for native kidney retention, and studied patients undergoing their first kidney transplant at our center from 1967 through 1989. Our patients and those in literature reports were characterized by age, sex, race, underlying renal disease, dialysis time, and survival. We found that: 1) Native kidney retention in dialysis and transplant patients has increased linearly over the past 10 to 20 years and is now greater than 90% in both groups; 2) ACKD occurs in ESRD patients with all types of underlying kidney disease. 3) ACKD affects CAPD patients and HD patients equally; 4) ACKD affects both sexes equally and age is not a factor in the development of ACKD; 5) there appears to be a greater prevalence of ACKD in black patients with ESRD as compared to white patients with ESRD; 6) the prevalence of ACKD is a function of time on dialysis; 7) the incidence of renal cancer in ESRD is increased over that of the general population and occurs 80% of the time in patients with ACKD; 8) renal cancer can develop at any time in patients with ESRD and also occurs in renal transplant recipients; 9) the incidence of renal cancer in ESRD is 5 to 7 times greater in males than in females, and blacks are affected nearly twice as often as whites; and 10) the 5-year survival of patients with renal cancer and ESRD is approximately 35%--similar to that of patients not on dialysis. ACKD is an important complication of ESRD and will grow in importance as the population at risk continues to increase. These results support the need for investigation of 3-year dialysis patients for the presence of cystic disease and appropriate therapy based on findings. Further study is needed to discern the quantitative importance of ACKD and renal cancers in renal transplant patients.