1. Patterns of Kidney Function Decline in Autosomal Dominant Polycystic Kidney Disease: A Post Hoc Analysis From the HALT-PKD Trials
- Author
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Godela M. Brosnahan, Kaleab Z. Abebe, Charity G. Moore, Frederic F. Rahbari-Oskoui, Kyongtae T. Bae, Jared J. Grantham, Robert W. Schrier, William E. Braun, Arlene B. Chapman, Michael F. Flessner, Peter C. Harris, Marie C. Hogan, Ronald D. Perrone, Dana C. Miskulin, Theodore I. Steinman, Vicente E. Torres, Theodore Steinman, Jesse Wei, Peter Czarnecki, Ivan Pedrosa, William Braun, Saul Nurko, Erick Remer, Arlene Chapman, Diego Martin, Frederic Rahbari-Oskoui, Pardeep Mittal, Vicente Torres, Ziad El-Zoghby, Peter Harris, James Glockner, Bernard King, Ronald Perrone, Neil Halin, Dana Miskulin, Robert Schrier, Godela Brosnahan, Berenice Gitomer, Cass Kelleher, Amirali Masoumi, Nayana Patel, Franz Winklhofer, Jared Grantham, Alan Yu, Connie Wang, Louis Wetzel, James E. Bost, Kyongtae Bae, J. Philip Miller, Paul A. Thompson, Josephine Briggs, Michael Flessner, Catherine M. Meyers, Robert Star, James Shayman, William Henrich, Tom Greene, Mary Leonard, Peter McCullough, Sharon Moe, Michael Rocco, and David Wendler
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education.field_of_study ,Creatinine ,medicine.medical_specialty ,PKD1 ,business.industry ,Population ,030232 urology & nephrology ,Autosomal dominant polycystic kidney disease ,Renal function ,030204 cardiovascular system & hematology ,medicine.disease ,Article ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,chemistry ,Nephrology ,Internal medicine ,Post-hoc analysis ,Polycystic kidney disease ,Medicine ,business ,education ,Kidney disease - Abstract
Background Previous clinical studies of autosomal dominant polycystic kidney disease (ADPKD) reported that loss of kidney function usually follows a steep and relentless course. A detailed examination of individual patterns of decline in estimated glomerular filtration rate (eGFR) has not been performed. Study Design Longitudinal post hoc analysis of data collected during the Halt Progression of Polycystic Kidney Disease (HALT-PKD) trials. Setting & Participants 494 HALT-PKD Study A participants (younger; preserved eGFR) and 435 Study B participants (older; reduced eGFR) who had more than 3 years of follow-up and 7 or more eGFR assessments. Measurements Longitudinal eGFR assessments using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation. Predictors Demographic, clinical, laboratory, and imaging features of participants. Outcomes Probability of linear and nonlinear decline patterns or of stable eGFR calculated for each participant from a Bayesian model of individual eGFR trajectories. Results Most (62.5% in Study A and 81% in Study B) participants had a linear decline in eGFR during up to 8 years of follow-up. A proportion (22% in Study A and 13% in Study B) of progressors had a nonlinear pattern. 15.5% of participants in Study A and 6% in Study B had a prolonged (≥4.5 years) period of stable eGFRs. These individuals (Study A) had significantly smaller total kidney volumes, higher renal blood flows, lower urinary albumin excretion, and lower body mass index at baseline and study end. In Study B, participants with reduced but stable eGFRs were older than the progressors. Two-thirds of nonprogressors in both studies had PKD1 mutations, with enrichment for weak nontruncating mutations. Limitations Relatively short follow-up of a clinical trial population. Conclusions Although many individuals with ADPKD have a linear decline in eGFR, prolonged intervals of stable GFRs occur in a substantial fraction. Lower body mass index was associated with more stable kidney function in early ADPKD.
- Published
- 2018
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