TY - JOUR
T1 - Long-term trajectory of kidney function in autosomal-dominant polycystic kidney disease
AU - Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease (CRISP)
AU - Yu, Alan S.L.
AU - Shen, Chengli
AU - Landsittel, Douglas P.
AU - Grantham, Jared J.
AU - Cook, Larry T.
AU - Torres, Vicente E.
AU - Chapman, Arlene B.
AU - Bae, Kyongtae Ty
AU - Mrug, Michal
AU - Harris, Peter C.
AU - Rahbari-Oskoui, Frederic F.
AU - Shi, Tiange
AU - Bennett, William M.
N1 - Publisher Copyright:
© 2019 International Society of Nephrology
PY - 2019/5
Y1 - 2019/5
N2 - 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.
AB - 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.
KW - ADPKD
KW - chronic kidney disease
UR - http://www.scopus.com/inward/record.url?scp=85063250968&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85063250968&partnerID=8YFLogxK
U2 - 10.1016/j.kint.2018.12.023
DO - 10.1016/j.kint.2018.12.023
M3 - Article
C2 - 30922668
AN - SCOPUS:85063250968
SN - 0085-2538
VL - 95
SP - 1253
EP - 1261
JO - Kidney international
JF - Kidney international
IS - 5
ER -