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Kidney Week

Abstract: SA-PO481

Gender-Specific Differences in Baseline Fluid and Solute Intake in the PREVENT-ADPKD Study

Session Information

  • ADPKD: Clinical Studies
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Genetic Diseases of the Kidney

  • 1001 Genetic Diseases of the Kidney: Cystic

Authors

  • Mannix, Carly, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
  • Wong, Annette, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
  • Zhang, Jennifer, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
  • Badve, Sunil V., St George Hospital, Kogarah, New South Wales, Australia
  • Boudville, Neil, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  • Harris, David C., The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
  • Lee, Vincent W.S., The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
  • Sud, Kamal, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
  • Erickson, Bradley J., Mayo Clinic, Rochester, Minnesota, United States
  • Torres, Vicente E., Mayo Clinic, Rochester, Minnesota, United States
  • Rangan, Anna M., The University of Sydney, Sydney, New South Wales, Australia
  • Allman-Farinelli, Margaret, The University of Sydney, Sydney, New South Wales, Australia
  • Rangan, Gopi, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia

Group or Team Name

  • PREVENT-ADPKD
Background

Adequate hydration may slow the postnatal growth of renal cysts in autosomal dominant polycystic kidney disease (ADPKD) by attenuating the release of arginine vasopressin (AVP). However, the efficacy, safety and feasibility of this approach, and whether baseline fluid and dietary solute intakes vary by gender are not known.

Methods

PREVENT-ADPKD is a 3-yr multi-centre randomized controlled trial determining the effect of Prescribed Fluid Intake (sufficient to reduce urine osmolality to ≤270 mOsmol coupled with reduced dietary solute intake) on the progression of height-corrected total kidney volume (Ht-TKV) compared to Usual Fluid Intake in ADPKD patients (eGFR≥30ml/min/1.73m2; Mayo Class 1B-1E). Recruitment was completed in May 2018.

Results

Of 1571 patients assessed for eligibility at 13 sites in Australia, 1295 were excluded due to ineligibility (n=1144) or declined to participate (n=151). The remaining 276 patients consented to the study, of whom 89 failed run-in (Mayo Subclass 1A, n=37; atypical kidneys, n=3; cannot do MRI, n=5; eGFR<30, n=7; pregnancy, n=2; non-compliance, n=31; and other exclusion criteria met, n=4) and 187 were randomised into Usual Fluid Intake (n=93) or Prescribed Fluid Intake (n=94). The median age of the randomised cohort was 43 yrs (range: 19-67; 94 women; 72% caucasian). At baseline, men had worse clinical characteristics of ADPKD (higher blood pressure, Ht-TKV and serum creatinine; P<0.001) but reported less kidney pain (P=0.03). Baseline 24hr urine volume did not differ by gender (P=0.85), whereas men had higher 24hr urine osmolality (26.6%), 24hr urine sodium excretion (31.0%), serum osmolality (1.7%) and serum copeptin (biomarker of AVP release) (116.1%) compared to women (P<0.001). Ninety percent of the cohort consumed caffeinated drinks but this did not differ by gender.

Conclusion

Baseline fluid intake is not affected by gender, but dietary sodium intake and AVP release are higher in men compared to women with ADPKD. These data support the importance of targeting both fluid and dietary solute intake to synergise the possible benefits of the intervention in PREVENT-ADPKD.

Funding

  • Commercial Support