Long-term trajectory of kidney function in autosomal-dominant polycystic kidney disease.

Autor:	Yu ASL; Division of Nephrology and Hypertension and the Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA. Electronic address: ayu@kumc.edu., Shen C; Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA., Landsittel DP; Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA., Grantham JJ; Division of Nephrology and Hypertension and the Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA., Cook LT; Department of Diagnostic Radiology, University of Kansas Medical Center, Kansas City, Kansas, USA., Torres VE; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA., Chapman AB; Division of Nephrology, University of Chicago School of Medicine, Chicago, Illinois, USA; Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA., Bae KT; Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA., Mrug M; Division of Nephrology, University of Alabama and the Department of Veterans Affairs Medical Center, Birmingham, Alabama, USA., Harris PC; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA., Rahbari-Oskoui FF; Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA., Shi T; Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA., Bennett WM; Legacy Good Samaritan Hospital, Portland, Oregon, USA.
Jazyk:	angličtina
Zdroj:	Kidney international [Kidney Int] 2019 May; Vol. 95 (5), pp. 1253-1261. Date of Electronic Publication: 2019 Mar 04.
DOI:	10.1016/j.kint.2018.12.023
Abstrakt:	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. (Copyright © 2019 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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