Cardiovascular risk factors and the impact on prognosis in patients with chronic kidney disease secondary to autosomal dominant polycystic kidney disease

Abstract

Background Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent hereditary renal disease. There is an increased rate of cardiovascular disease (CVD) in ADPKD. In this study, we evaluate the prevalence of cardiovascular risk factors, the achievement rates for treatment goals and cardiovascular events (CVE) in ADPKD and their relations with asymptomatic CVD in CKD from other etiologies (CKDoe) and controls. Methods We evaluated 2445 CKD patients (2010–2012). The information collected was: clinical, anthropometric and analytical parameters, treatments and CVD evaluation (intima-media thickness (IMT), atheromatous plaque presence and ankle-brachial index (ABI)). Laboratory, vital status, CVE and hospitalizations were collected for 4 years. Results ADPKD patients had a worse renal function and worst achievement of blood pressure, higher parathormone levels but lower proteinuria compared to CKDoe. ADPKD patients presented lower IMT values than other groups, however, an intermediate rate of pathologic ABI and atheromatous plaque was present. More than half of the patients received statins, achieving LDL-c levels < 100 only in 50 and 39.8% of them (ADPKD and CKDoe respectively). The number of CVE during the follow-up period was low. In adjusted Cox regression model, ADPDK had the lowest occurrence of CVE of all three groups (HR:0.422, 95%CI 0.221–0.808, p = 0.009). Conclusion ADPKD patients show intermediate control rates of CVD. A better control of CVD risk seems to be related with a lower load of CVD compared to other groups, which may lead in the long term to a better prognosis. Further investigation is necessary to determine cardiovascular prognosis in ADPKD.

Is autosomal dominant polycystic kidney disease an early sweet disease?

“…•17% NODAT in ADPKD vs. 7.4% in matched controls vs. 8% in non-matched controls Wilson et al [30] 429 kidney allografts in non-diabetic patients •13.4% NODAT in ADPKD vs. 5.2% in non-ADPKD Yajnik et al [31] 18 ADPKD vs. 112 non-ADPKD •55.6% NODAT in ADPKD vs. 28% NODAT in non-ADPKD other causes [46]. In this recent study, 1751 patients (132 ADPKD, 1121 with CKD from other causes, and 498 non-CKD patients) were followed for 4 years.…”

Cardiovascular Manifestations and Management in ADPKD

“…Longitudinal population studies in patients with ADPKD over the last decade have documented reduced rates of hypertension, LVH, and progression to kidney failure due to earlier diagnosis, engagement with healthcare professionals, and more rigorous CVD risk management. 17 , 148 , 149 Despite this, CVD remains the main cause of mortality, and patients with ADPKD experience more severe cardiovascular events than the general population and have risk factors that are not optimally controlled. 117 , 138 , 148 The pathogenesis of CVD is complex and evolves with progression of ADPKD during life.…”

“… 17 , 148 , 149 Despite this, CVD remains the main cause of mortality, and patients with ADPKD experience more severe cardiovascular events than the general population and have risk factors that are not optimally controlled. 117 , 138 , 148 The pathogenesis of CVD is complex and evolves with progression of ADPKD during life. The clinical landscape of ADPKD therapies has changed with the introduction and increasing use of the vasopressin-2 receptor antagonist, tolvaptan, which is the first disease-modifying therapy that attenuates kidney cyst growth.…”

Short-Term Dapagliflozin Administration in Autosomal Dominant Polycystic Kidney Disease—A Retrospective Single-Arm Case Series Study

“…Cardiovascular disease (CVD) is the major cause of mortality in ADPKD cases and contributes to a significant disease burden [14][15][16][17]. Patients with ADPKD experience CVD events with greater severity and have an increased risk of CVD-related death as compared to the general population, with 33% of those mortalities mainly due to ischemic heart disease or congestive heart failure [18].…”