Pain and Obesity in Autosomal Dominant Polycystic Kidney Disease: A Post Hoc Analysis of the Halt Progression of Polycystic Kidney Disease (HALT-PKD) Studies

Kristen L. Nowak, Kaleigh Murray, Zhiying You, Berenice Gitomer, Godela Brosnahan, Kaleab Z. Abebe, William Braun, Arlene Chapman, Peter C. Harris, Dana Miskulin, Ronald Perrone, Vicente Torres, Theodore Steinman, Alan Yu, Michel Chonchol

Research output: Contribution to journalArticlepeer-review

Abstract

Rationale & Objective: Pain is a frequent complication of autosomal dominant polycystic kidney disease (ADPKD) and includes back and abdominal pain. We hypothesized that in adults with early- and late-stage ADPKD, overweight and obesity are independently associated with greater self-reported back, abdominal, and radicular pain at baseline and that weight loss would be associated with decreased pain over a follow-up period. Study Design: Post hoc analysis of pooled data from 2 randomized trials. Setting & Participants: Participants in the HALT-PKD study A or B. 867 individuals were included in a cross-sectional analysis. 4,248 observations from 871 participants were included in a longitudinal analysis. Predictor: Overweight and obesity (cross-sectional); annual change in weight as a time-varying predictor (longitudinal). Outcome: Pain (Likert-scale responses; cross-sectional); annual change in pain (binary outcome of worsening pain or not worsening; longitudinal). Analytical Approach: Multivariable ordinal logistic regression (cross-sectional); generalized estimating equation analysis (longitudinal). Results: Participants were aged 42±10 years and baseline estimated glomerular filtration rate was 71±26 mL/min/1.73 m2. Back, abdominal, and radicular pain were reported more frequently in individuals with increasing body mass index category (all P < 0.05 for trend). After multivariable adjustment, obesity was associated with increased odds of greater back and radicular pain, but not abdominal pain. Associations remained similar after further adjustment for baseline height-adjusted kidney and liver volume (study A only, n = 457); back pain: OR, 1.88 (95% CI, 1.15-3.08); and radicular pain: OR, 2.92 (95% CI, 1.45-5.91). Longitudinally (median follow-up, 5 years), weight loss (annual decrease in weight ≥ 4%) was associated with decreased adjusted odds of worsening back pain (OR, 0.87 [95% CI, 0.76-0.99]) compared with the reference group (stable weight). Limitations: Post hoc, associative analysis. Conclusions: In early- and late-stage ADPKD, obesity was associated with greater back and radicular pain independent of total kidney/liver volume. Mild weight loss was associated with favorable effects on back pain.

Original languageEnglish (US)
JournalKidney Medicine
DOIs
StateAccepted/In press - 2021

Keywords

  • Body mass index
  • obesity
  • pain
  • polycystic kidney disease
  • weight loss

ASJC Scopus subject areas

  • Internal Medicine
  • Nephrology

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