Long-term trajectory of kidney function in autosomal-dominant polycystic kidney disease
Autosomal dominant polycystic kidney disease (ADPKD) is characterized by cyst and kidney growth, which is hypothesized to cause loss of functioning renal mass and eventually end-stage kidney disease. However, the time course of decline in glomerular filtration rate (GFR) is poorly defined. The Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease study is a 14-year observational cohort study of 241 adults with ADPKD. As an estimate of the rate of kidney growth, participants were stratified into 5 subclasses based on baseline age and magnetic resonance imaging measurements of total kidney volume (TKV) according to the method of Irazabal.
GFR trajectories spanning over four decades of life were reconstructed and fitted using mixed polynomial models, which were validated using data from the HALT-PKD study. GFR trajectories were nonlinear, with a period of relative stability in most participants, followed by accelerating decline. The shape and slope of these trajectories were strongly associated with baseline Irazabal class. Patients with PKD1 mutations had a steeper GFR decline than patients with PKD2 mutations or with no detected mutation, largely mediated by the effect of genotype on Irazabal class.
Thus, GFR decline in ADPKD is nonlinear, and its trajectory throughout adulthood can be predicted from a single measurement of kidney volume. These models can be used for clinical prognostication, clinical trial design, and patient selection for clinical interventions. Our findings support a causal link between growth in kidney volume and GFR decline, adding support for the use of TKV as a surrogate endpoint in clinical trials.
Journal of Clinical Nephrology and Therapeutics publishes scientific manuscripts that are directly or indirectly based on variegated aspects of clinical nephrology, diabetic nephropathy, pediatric nephrology, renal physiology, renal histopathology, immunobiology, intensive care nephrology and ischemic nephropathy.
The journal most specifically emphasizes on the propagation of research developments that may contribute in the furtherance of research and clinical implementation of novel tools as well as adept clinical techniques including renal transplantation, dialysis, diagnostic kidney imaging, aging and kidney disease, hemodialysis, body fluid volume composition, nephron endowment and erythropoietin therapy.
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