MO064ASSESSMENT OF KIDNEY SURVIVAL IN PATIENTS AFFECTED BY ADPKD

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Carmen García Rabaneda ◽  
Ana Isabel Morales García ◽  
María Luz Bellido Díaz ◽  
María del Mar Del Águila García ◽  
Antonio M Poyatos Andújar ◽  
...  

Abstract Background and Aims Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary nephropathy that causes kidney failure and the need for renal replacement therapy (RRT). It has recently been established that there is a genotype-phenotype relationship for this disease, with differences in the age of access to TRS if the involvement occurs in the PKD1 or PKD2 gene and if the variant is truncating or not. Identifying patients at high risk for rapid progression has become increasingly important given the emergence of potential new treatments such as tolvaptan. Method Studies are carried out in 23 families affected in which a genetic study has previously been the variant identified. For the survival analysis, the Kaplan-Meier test was performed. Data are expressed in terms of mean ± SD, median and %. Results The data described in Table 1 show that there is huge variability of access to RRT according to the type of variant found in the family. We found families in which the age at which kidney failure occurred ranged from 48.03 (28.38-67.68) years to families in which RRT began with 78.04 (65.06-91.03). We observed that those families that present a variant with a stop or frameshift codon suffer a loss of kidney function before those that present a missense variant. In the variants with a stop or frameshift codon, we observed that they ranged from 48.03 (28.38-67.68) for the variant c.7480G> T (p.Glu2494 *) to 73.75 (61.52-85, 98) in variant c.9616C> T p.Gln3203 *. In those missense variants, the age of access to RRT ranges from 62.17 (60.43-63.91) to 77.13 (71.56-82.71) Conclusion Advances in studies of the genes involved in ADPKD are expanding the identification of new variants and the knowledge about their involvement in the progression of the disease. The correlation between genotype and kidney disease will provide a useful clinical prognosis for ADPKD and will allow us to establish current and future treatments.

2018 ◽  
Vol 48 (4) ◽  
pp. 308-317 ◽  
Author(s):  
Mónica Furlano ◽  
Irene Loscos ◽  
Teresa Martí ◽  
Gemma Bullich ◽  
Nadia Ayasreh ◽  
...  

Background: Autosomal dominant polycystic kidney disease (ADPKD) causes the development of renal cysts and leads to a decline in renal function. Limited guidance exists in clinical practice on the use of tolvaptan. A decision algorithm from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Working Groups of Inherited Kidney Disorders and European Renal Best Practice (WGIKD/ERBP) has been proposed to identify candidates for tolvaptan treatment; however, this algorithm has not been assessed in clinical practice. Methods: Eighteen-month cross-sectional, unicenter, observational study assessing 305 consecutive ADPKD patients. The ERA-EDTA WGIKD/ERBP algorithm with a stepwise approach was used to assess rapid progression (RP). Subsequently, expanded criteria based on the REPRISE trial were applied to evaluate the ­impact of extended age (≤55 years) and estimated glomerular filtration rate (eGFR; ≥25 mL/min/1.73 m2). Results: Historical eGFR decline, indicative of RP, was fulfilled in 26% of 73 patients who were candidates for RP assessment, mostly aged 31–55 years. Further tests including ultrasound and MRI measurements of kidney volume plus genetic testing enabled the evaluation of the remaining patients. Overall, 15.7% of patients met the criteria for rapid or likely RP using the algorithm, and the percentage increased to 27% when extending age and eGFR. Conclusions: The ERA-EDTA WGIKD/ERBP algorithm provides a valuable means of identifying in routine clinical practice patients who may be eligible for treatment with tolvaptan. The impact of a new threshold for age and eGFR may increase the percentage of patients to be treated.


2019 ◽  
Vol 50 (4) ◽  
pp. 281-290 ◽  
Author(s):  
Vera C. Wulfmeyer ◽  
Bernd Auber ◽  
Hermann Haller ◽  
Roland Schmitt

Background: Tolvaptan can slow down renal function decline in autosomal dominant polycystic kidney disease (­ADPKD). While there is consensus across international recommendations that the drug should only be used in patients with high risk of rapid progression, identification criteria for rapid progression vary. Here, we investigated different assessment strategies using a real-life ADPKD cohort. Methods: Observational retrospective cohort analysis. The study included 131 ADPKD patients aged 19–78 years who were referred to the Hannover Medical School outpatient clinic for evaluation of tolvaptan treatment. Six different assessment strategies for tolvaptan eligibility were tested for each patient. Comparative analysis for different assessments was performed in the total study population, the subpopulation with available computed tomography/magnetic resonance imaging data, and the genotyped subpopulation. Results: Comparing 6 assessment strategies revealed strong variations in the individual selection processes resulting in treatment recommendations for 14.5–64.9% of patients. The highest patient number was selected by the Scottish and the lowest by the Japanese approach. Few patients had positive recommendations by all 6 systems, but strong congruency was observed between the Scottish, U.K. and Canadian patient selection. The lowest number of overlapping patients was found between the Japanese and the ERA-EDTA selection. Important discrepancies were also found between the ERA-EDTA and the U.S. system due to different emphases on parameters of kidney function versus kidney volume. Limitations of the study included the restricted sample size, heterogeneity in parameter availability and lack of outcome data. Conclusions: The study draws attention to important discrepancies between different decision algorithms for tolvaptan eligibility in ADPKD patients.


Author(s):  
Carsten Bergmann ◽  
Nadina Ortiz-Brüchle ◽  
Valeska Frank ◽  
Klaus Zerres

Renal cysts of different aetiology are a common diagnosis in paediatric nephrology. The classification is usually based on the clinical picture, morphology, and family history. In syndromic forms, additional features have to be evaluated. Most common are cystic dysplastic kidneys with a broad phenotypic spectrum ranging from asymptomatic clinical courses in unilateral cases to severe, lethal manifestations in patients with considerable bilateral involvement. Simple cysts are rare. Polycystic kidneys are usually subdivided according to the mode of inheritance into autosomal recessive and autosomal dominant polycystic kidney disease. The most useful investigation in order to distinguish between these two types is the family history with parental ultrasound and demonstration of polycystic kidneys in one parent in the majority of cases with dominant polycystic kidney disease. Finally, cystic kidneys are associated with a variety of hereditary, usually recessive syndromes affecting cilia.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mark Thomas ◽  
Pedro Henrique Franca Gois ◽  
Belinda E. Butcher ◽  
Michelle H. T. Ta ◽  
Greg W. Van Wyk

Abstract Background Tolvaptan is the only available disease-modifying treatment for autosomal dominant polycystic kidney disease (ADPKD). Prior to October 2020 access to tolvaptan in Australia was restricted by a controlled monitoring and distribution program called IMADJIN®. Focusing on hepatic safety, the IMADJIN® program collected real-world data on patients with ADPKD. A retrospective, secondary data analysis of the IMADJIN® dataset was undertaken to determine the time to all-cause discontinuation of tolvaptan in Australia. Methods Demographic and treatment data from 17 September 2018 to 30 September 2020 were extracted from the IMADJIN® dataset. Treatment persistence was analyzed using Kaplan-Meier methods, and Cox’s proportional hazard models were used to analyze differences in treatment persistence by age, sex and location. Results Four hundred seventy-nine patients with ADPKD were included in the analysis. After a median follow-up of 12.0 months (95% confidence interval [CI] 2.6, 23.4), the Kaplan-Meier estimation of 12-month persistence was 76.7% (95% CI 72.2, 80.5%). 114 (23.8%) patients discontinued treatment; sex, state, and remoteness did not significantly affect treatment persistence. Patients in the youngest tertile were more likely to discontinue compared to older ages (p = 0.049). Reasons for discontinuation included: aquaretic tolerability (4.2%), hepatic adverse events (abnormal liver function tests) (2.1%), disease progression (1.5%), and acute kidney injury (0.2%). Patients with a lack of aquaretic tolerance had shorter time to discontinuation. Hepatic toxicity events were initially observed 3 months after tolvaptan initiation and were less prevalent over time. Conclusions Persistence to tolvaptan in the real-world IMADJIN® dataset was 76%. Discontinuation due to hepatic events was low. Prescribers should take extra care when initiating treatment in younger patients as they are more likely to discontinue tolvaptan compared to older individuals. Nevertheless, the precise reason for this observation remains to be elucidated.


Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0004292021
Author(s):  
Brian E. Jones ◽  
Yaman G. Mkhaimer ◽  
Laureano J. Rangel ◽  
Maroun Chedid ◽  
Phillip J. Schulte ◽  
...  

Background: Autosomal dominant polycystic kidney disease (ADPKD) has phenotypic variability only partially explained by established biomarkers that do not readily assess pathologically important factors of inflammation and kidney fibrosis. We evaluated asymptomatic pyuria, a surrogate marker of inflammation, as a biomarker for disease progression. Methods: We performed a retrospective cohort study of adult patients with ADPKD. Patients were divided into asymptomatic pyuria (AP) and no pyuria (NP) groups. We evaluated the effect of pyuria on kidney function and kidney volume. Longitudinal models evaluating kidney function and kidney volume rate of change with respect to incidences of asymptomatic pyuria were created. Results: There were 687 included patients (347 AP, 340 NP). The AP group had more female (65.1% vs 49.4%). Median age at kidney failure was 86 and 80 years in NP and AP groups, respectively (Log-rank, p=0.49) for patients with Mayo Imaging Class (MIC)1A-1B as compared to 59 and 55 years for patients with MIC1C-1D-1E (Log-rank, p=0.02). Compared to NP group, the rate of kidney function (ml/min/1.73m2/year) decline shifted significantly after detection of asymptomatic pyuria in models including all patients (-1.48, p<0.001), MIC 1A-B patients (-1.79 , p<0.001), MIC 1C-1D-1E patients (-1.18, p<0.001), and PKD1 patients (-1.04, p<0.001). Models evaluating kidney volume rate of growth showed no change after incidence of asymptomatic pyuria as compared to NP group. Conclusions: Asymptomatic pyuria is associated with kidney failure and faster kidney function decline irrespective of the ADPKD gene, cystic burden, and cystic growth. These results support asymptomatic pyuria as an enriching prognostic biomarker for the rate of disease progression.-


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