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Kidney Week

Abstract: PO1574

Identification of Factors Associated with Progression, Prognosis, and Tolvaptan Indication in Polycystic Kidney Disease Patients

Session Information

Category: Genetic Diseases of the Kidneys

  • 1001 Genetic Diseases of the Kidneys: Cystic

Authors

  • Tsirpanlis, George I., Department of Nephrology, General Hospital of Athens “G. Gennimatas", Athens, Attiki, Greece
  • Kostopoulou, Myrto, Department of Nephrology, General Hospital of Athens “G. Gennimatas", Athens, Attiki, Greece
  • Louka, Michaela, Department of Nephrology, General Hospital of Athens “G. Gennimatas", Athens, Attiki, Greece
  • Fokas, Stavros, Department of Nephrology, General Hospital of Athens “G. Gennimatas", Athens, Attiki, Greece
  • Tigka, Eirini, Department of Nephrology, General Hospital of Athens “G. Gennimatas", Athens, Attiki, Greece
  • Drakopoulos, Angelos, Department of Nephrology, General Hospital of Athens “G. Gennimatas", Athens, Attiki, Greece
  • Gkika, Vasiliki, Department of Nephrology, General Hospital of Athens “G. Gennimatas", Athens, Attiki, Greece
  • Markou, Niki, Department of Nephrology, General Hospital of Athens “G. Gennimatas", Athens, Attiki, Greece
  • Kanellopoulou, Konstantina, Department of Nephrology, General Hospital of Athens “G. Gennimatas", Athens, Attiki, Greece
  • Tsagkatakis, Michail, "Geniki Apikonistiki”, Medical Imagining, Athens, Attiki, Greece
Background

The identification of risk factors for the progression of Autosomal Dominant Polycystic Kidney Disease (ADPKD) is an emerging field. The present study explores the associations between epidemiological, clinical and imagining data in a large cohort of ADPKD patients

Methods

All patients included in the study had a Magnetic Resonance Imaging (MRI) for measurement of Total Kidney Volume (TKV). For all patients, the Mayo Clinic Imaging Category (MCIC) and the respective prediction for End Stage Renal Disease (ESRD) were calculated. Patients eligible for tolvaptan treatment (MCIC 1C,1D,1E, age <55 years old and estimated-GFR (e-GFR) ≥25ml/min) were identified. Individual medical history, clinical and laboratory data were examined for associations with renal and imaging parameters using linear regression models

Results

158 patients in total were included. Based on measurements of height-adjusted TKV (ht-TKV) and age, 5% of the patients were classified as 1A, 20% as 1B, 34% 1C, 25% 1D and 16% 1E, MCIC. In multivariable analysis, patients' age (p=0.01), male sex (p<0.001), parent’s age at time of ESRD (p<0.001) and proteinuria (p=0.04) were associated with ht-TKV. Parent’s age at ESRD differed significantly between the MCICs of the offspring (mean±(SD)), 70.83 (12.90) in 1A, 63.79 (11.39) in 1B, 57.32 (10.42) in 1C, 51.42 (9.18) in 1D and 47.94 (5.73) years old in 1E, (p<0.001). Similarly, there were differences in the presence and age of hypertension onset (p=0.004 and p=0.003, respectively). In 104 patients eligible for tolvaptan treatment, age at ADPKD diagnosis, age at hypertension onset and parent’s age reaching at ESRD were all significantly lower (p<0.001 for all) when compared to non-eligible patients. Finally, factors associated with the prediction score of ESRD (e-GFR 10ml/min) were hypertension, uric acid and the age at ESRD of the affected parent (p=0.001, 0.02, 0.01, respectively)

Conclusion

The age at which an affected parent had reached ESRD, as heritability estimator, was significantly associated with a worst phenotype, prognosis and tolvaptan indication. Early diagnosis of the disease, hypertension and its early onset, proteinuria and male sex are also possible risk factors for the progression of ADPKD