Longitudinal Assessment of Left Ventricular Mass in Autosomal Dominant Polycystic Kidney Disease

• Type of Material: Article
• Authors: Taimur Dad, Tufts Medical Center; Kaleab Z. Abebe, University of Pittsburgh; K. Ty Bae, University of Pittsburgh; Diane Comer, University of Pittsburgh; Vicente E. Torres, Mayo Clinic; Peter G. Czarnecki, Brigham and Women's Hospital; Robert W. Schrier, University of Colorado; Theodore I. Steinman, Beth Israel Deaconess Medical Center; Charity G. Moore, University of Pittsburgh; Arlene B Chapman, Emory University; Diana Kaya, University of Texas MD Anderson Cancer Center; Cheng Tao, University of Pittsburgh; William E. Braun, Cleveland Clinic Foundation; Franz T. Winklhofer, University of Kansas Medical Center; Godela Brosnahan, University of Colorado School of Medicine; Marie C. Hogan, Mayo Clinic; Dana C. Miskulin, Tufts Medical Center; Frederic Rahbari Oskoui, Emory University; Michael F. Flessner, National Institute of Diabetes and Digestive and Kidney Diseases; Ronald D. Perrone, Tufts Medical Center
• Language: English
• Date: 2018-05-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2018 International Society of Nephrology Introduction
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ekir.2017.12.011
• Title of Journal or Parent Work: Kidney International Reports
• ISSN: 2468-0249
• Volume: 3
• Issue: 3
• Start Page: 619
• End Page: 624
• Grant/Funding Information: The HALT-PKD study was supported by cooperative agreements from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (DK62408, DK62401, DK62410, DK62402, and DK62411).; The Polycystic Kidney Disease Foundation provided financial support and recruitment assistance for the enrollment phase of HALTPKD; The HALT-PKD study and this publication were also supported by grants from the National Center for Research Resources (RR000039 Emory, RR000051 Colorado, RR00585 Mayo, RR000054 Tufts Medical Center, and RR23940 Kansas and UL1 RR025008 Emory, UL1 RR025780 Colorado, UL1 RR024150 Mayo, UL1 RR025752 Tufts, and UL1 RR024992 Washington University).; TD is supported by NIDDKT32-DK007777 from the National Institutes of Health National Institute of Diabetes, Digestive and Kidney Diseases.
• Keywords: left ventricular hypertrophy; hypertension; autosomal dominant polycystic kidney disease; left ventricular mass index
• Research Categories: Health Sciences, General; Health Sciences, Medicine and Surgery; Health Sciences, Oncology

Abstract

The high burden of cardiovascular morbidity and mortality in autosomal dominant polycystic kidney disease (ADPKD) is related to development of hypertension and left ventricular hypertrophy. Blood pressure reduction has been shown to reduce left ventricular mass in ADPKD; however, moderators and predictors of response to lower blood pressure are unknown. Methods: This was a post hoc cohort analysis of HALT PKD study A, a randomized placebo controlled trial examining the effect of low blood pressure and single versus dual renin−angiotensin blockade in early ADPKD. Participants were hypertensive ADPKD patients 15 to 49 years of age with estimated glomerular filtration rate (eGFR) > 60 ml/min per 1.73 m2across 7 centers in the United States. Predictors included age, sex, baseline eGFR, systolic blood pressure, total kidney volume, serum potassium, and urine sodium, potassium, albumin, and aldosterone. Outcome was left ventricular mass index (LVMI) measured using 1.5-T magnetic resonance imaging at months 0, 24, 48, and 60. Results: Reduction in LVMI was associated with higher baseline systolic blood pressure and larger kidney volume regardless of blood pressure control group assignment (P < 0.001 for both). Male sex and baseline eGFR were associated with a positive annual slope in LVMI (P < 0.001 and P = 0.07, respectively). Conclusion: Characteristics associated with higher risk of progression in ADPKD, including higher systolic blood pressure, larger kidney volume, and lower eGFR are associated with improvement in LVMI with intensive blood pressure control, whereas male sex is associated with a smaller slope of reduction in LVMI.