Evaluation of advanced imaging biomarkers at kidney failure in patients with ADPKD: a pilot study.

Background: Autosomal dominant polycystic kidney disease (ADPKD) presents with variable disease severity and progression. Advanced imaging biomarkers may provide insights into cystic and non-cystic processes leading to kidney failure in different age groups.
Methods: This pilot study included 39 ADPKD patients with kidney failure, stratified into three age groups (<46, 46-56, >56 years old). Advanced imaging biomarkers were assessed using an automated instance cyst segmentation tool. The biomarkers were compared with an age- and sex-matched ADPKD cohort in early chronic kidney disease (CKD).
Results: Ht-total parenchymal volume correlated negatively with age at kidney failure. The median Ht-total parenchymal volume was significantly lower in patients older than 56 years. Cystic burden was significantly higher at time of kidney failure, especially in patients who reached it before age 46 years. The cyst index at kidney failure was comparable across age groups and Mayo Imaging Classes. Advanced imaging biomarkers showed higher correlation with Ht-total kidney volume in early CKD than at kidney failure. Cyst index and parenchymal index were relatively stable over 5 years prior to kidney failure, whereas Ht-total cyst volume and cyst parenchymal surface area increased significantly.
Conclusion: Age-related differences in advanced imaging biomarkers suggest variable pathophysiological mechanisms in ADPKD patients with kidney failure. Further studies are needed to validate the utility of these biomarkers in predicting disease progression and guiding treatment strategies.
Competing Interests: V.E.T. receives grants for preclinical research and clinical trials from Palladio Biosciences, Mironid, Blueprint Medicines, Tribune, Sanofi, and Reata and Regulus. He reports consultancy agreements with uResearch Technology and MFMER for imaging analytics for PCKD and repurposing of probenecid to treat PCKD. He reports royalties for system and method of classifying ADPKD. He is a member of the International Society of Nephrology Kaplan award committee, the American Society of Nephrology editorial board and the PKD Foundation advisory board. P.C.H. reports receiving grants and/or research reagents from Amgen, Inc., Bayer AG, Genzyme Corporation, GlaxoSmithKline, Mitobridge Inc., Otsuka Pharmaceuticals, Palladio Biosciences, Regulus Therapeutics and Vertex Pharmaceuticals, all outside of the submitted work. P.C.H. also reports a position on the Clinical Advisory Board of Mironid, honoraria from Otsuka Pharmaceuticals and Vertex Pharmaceuticals, and other fees from Otsuka Pharmaceuticals. F.T.C. receives research funding from Natera Inc. and Otsuka Pharmaceuticals. He is Chair of the educational advisory panel at the PKD foundation in the USA. All others authors declared no conflict of interest.
(© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.)