Autosomal dominant polycystic kidney disease (ADPKD) occurs at conception and is often diagnosed decades prior to kidney failure. Nephrology care and transplantation access should be independent of race and ethnicity. However, institutional racism and barriers to health care may affect patient outcomes in ADPKD. We sought to ascertain the effect of health disparities on outcomes in ADPKD by examining age at onset of kidney failure and access to preemptive transplantation and transplantation after dialysis initiation.

Retrospective cohort analyses of adults with ADPKD in the United States Renal Data System from January 2000 to June 2018 were merged to US Census income data and evaluated by self-reported race and ethnicity. Age at kidney failure was analyzed in a linear model, and transplant rates before and after dialysis initiation were analyzed in logistic and proportional hazards models in Black and Hispanic patients with ADPKD compared with White patients with ADPKD.

A total of 41,485 patients with ADPKD were followed for a median of 25 (interquartile range, 5–54) months. Mean age was 56±12 years; 46% were women, 13% were Black, and 10% were Hispanic. Mean ages at kidney failure were 55±13, 53±12, and 57±12 years for Black patients, Hispanic patients, and White patients, respectively. Odds ratios for preemptive transplant were 0.33 (95% confidence interval, 0.29 to 0.38) for Black patients and 0.50 (95% confidence interval, 0.44 to 0.56) for Hispanic patients compared with White patients. Transplant after dialysis initiation was 0.61 (95% confidence interval, 0.58 to 0.64) for Black patients and 0.78 (95% confidence interval, 0.74 to 0.83) for Hispanic patients.

Black and Hispanic patients with ADPKD reach kidney failure earlier and are less likely to receive a kidney transplant preemptively and after initiating dialysis compared with White patients with ADPKD.

常染色体显性多囊肾病 (ADPKD) 发生在受孕时，通常在肾衰竭前数十年被诊断出来。肾病护理和移植机会应独立于种族和民族。然而，制度上的种族主义和医疗保健障碍可能会影响 ADPKD 患者的治疗结果。我们试图通过检查肾衰竭发病年龄以及抢先移植和透析开始后移植的机会来确定健康差异对 ADPKD 结局的影响。

将 2000 年 1 月至 2018 年 6 月美国肾脏数据系统中 ADPKD 成人患者的回顾性队列分析合并到美国人口普查收入数据中，并根据自我报告的种族和民族进行评估。与患有 ADPKD 的白人患者相比，在线性模型中分析肾衰竭时的年龄，并在逻辑和比例风险模型中分析透析开始之前和之后的移植率。

共有 41,485 名 ADPKD 患者接受了中位随访 25 个月（四分位距，5-54）个月。平均年龄为 56±12 岁； 46% 是女性，13% 是黑人，10% 是西班牙裔。黑人患者、西班牙裔患者和白人患者发生肾衰竭的平均年龄分别为 55±13、53±12 和 57±12 岁。与白人患者相比，黑人患者优先移植的优势比为 0.33（95% 置信区间，0.29 至 0.38），西班牙裔患者为 0.50（95% 置信区间，0.44 至 0.56）。黑人患者透析开始后的移植率为 0.61（95% 置信区间，0.58 至 0.64），西班牙裔患者为 0.78（95% 置信区间，0.74 至 0.83）。

与患有 ADPKD 的白人患者相比，患有 ADPKD 的黑人和西班牙裔患者更早出现肾衰竭，并且在开始透析后抢先接受肾移植的可能性较小。