Emerging non-pharmacological interventions in ADPKD: an update on dietary advices for clinical practice

Meijer, Esther; Gansevoort, Ron T.

doi:10.1097/mnh.0000000000000734

Cited by 9 publications

(4 citation statements)

References 72 publications

(89 reference statements)

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“…Limiting alcohol intake reduces blood pressure and malignancy risk among the general population. 62 , 63 In patients with ADPKD, we recommend limiting or avoiding the use of alcohol in line with guidance for the general public.…”

Section: Methodsmentioning

confidence: 99%

How Does ADPKD Severity Differ Between Family Members?

Yeung,

Fryml,

Lanktree

2024

Kidney International Reports

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Section: Methodsmentioning

confidence: 99%

How Does ADPKD Severity Differ Between Family Members?

Yeung,

Fryml,

Lanktree

2024

Kidney International Reports

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“…Unless it is deemed clinically necessary, antihypertensive treatment will not be changed during the study. Patients will be reminded to adhere to a dietary sodium chloride intake of ≤ 5 g/day and to avoid a protein intake of ≥ 1.3 g/kg/day, as is recommended for ADPKD patients [ 25 ]. The tolvaptan dose can be reduced for clinical reasons (at the discretion of the treating physician), but tolvaptan will not up-titrated during the study period to minimize bias for the primary and secondary endpoints.…”

Section: Methodsmentioning

confidence: 99%

HYDROchlorothiazide versus placebo to PROTECT polycystic kidney disease patients and improve their quality of life: study protocol and rationale for the HYDRO-PROTECT randomized controlled trial

Bais,

Meijer,

Kramers

et al. 2024

Trials

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Background Autosomal dominant polycystic kidney disease (ADPKD) leads to progressive renal cyst formation and loss of kidney function in most patients. Vasopressin 2 receptor antagonists (V2RA) like tolvaptan are currently the only available renoprotective agents for rapidly progressive ADPKD. However, aquaretic side effects substantially limit their tolerability and therapeutic potential. In a preliminary clinical study, the addition of hydrochlorothiazide (HCT) to tolvaptan decreased 24-h urinary volume and appeared to increase renoprotective efficacy. The HYDRO-PROTECT study will investigate the long-term effect of co-treatment with HCT on tolvaptan efficacy (rate of kidney function decline) and tolerability (aquaresis and quality of life) in patients with ADPKD. Methods The HYDRO-PROTECT study is an investigator-initiated, multicenter, double-blind, placebo-controlled, randomized clinical trial. The study is powered to enroll 300 rapidly progressive patients with ADPKD aged ≥ 18 years, with an eGFR of > 25 mL/min/1.73 m2, and on stable treatment with the highest tolerated dose of tolvaptan in routine clinical care. Patients will be randomly assigned (1:1) to daily oral HCT 25 mg or matching placebo treatment for 156 weeks, in addition to standard care. Outcomes The primary study outcome is the rate of kidney function decline (expressed as eGFR slope, in mL/min/1.73 m2 per year) in HCT versus placebo-treated patients, calculated by linear mixed model analysis using all available creatinine values from week 12 until the end of treatment. Secondary outcomes include changes in quality-of-life questionnaire scores (TIPS, ADPKD-UIS, EQ-5D-5L, SF-12) and changes in 24-h urine volume. Conclusion The HYDRO-PROTECT study will demonstrate whether co-treatment with HCT can improve the renoprotective efficacy and tolerability of tolvaptan in patients with ADPKD.

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“…Likewise, the effect of alcohol consumption on these patients has not been specifically tested. However, the universal recommendations for patients with CKD and for the general population are equally valid [ 48 ].…”

Section: Effects Of Dietary Modification On Adpkd Progressionmentioning

confidence: 99%

Dietary Aspects and Drug-Related Side Effects in Autosomal Dominant Polycystic Kidney Disease Progression

Quiroga

Torrá

2022

Nutrients

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Autosomal dominant polycystic kidney disease (ADPKD) is the most commonly inherited kidney disease. In the absence of targeted therapies, it invariably progresses to advanced chronic kidney disease. To date, the only approved treatment is tolvaptan, a vasopressin V2 receptor antagonist that has been demonstrated to reduce cyst growth and attenuate the decline in kidney function. However, it has various side effects, the most frequent of which is aquaresis, leading to a significant discontinuation rate. The strategies proposed to combat aquaresis include the use of thiazides or metformin and a reduction in the dietary osmotic load. Beyond the prescription of tolvaptan, which is limited to those with a rapid and progressive decline in kidney function, dietary interventions have been suggested to protect against disease progression. Moderate sodium restriction, moderate protein intake (up to 0.8 g/kg/day), avoidance of being overweight, and increased water consumption are recommended in ADPKD guidelines, though all with low-grade evidence. The aim of the present review is to critically summarize the evidence on the effect of dietary modification on ADPKD and to offer some strategies to mitigate the adverse aquaretic effects of tolvaptan.

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Emerging non-pharmacological interventions in ADPKD: an update on dietary advices for clinical practice

Cited by 9 publications

References 72 publications

How Does ADPKD Severity Differ Between Family Members?

How Does ADPKD Severity Differ Between Family Members?

HYDROchlorothiazide versus placebo to PROTECT polycystic kidney disease patients and improve their quality of life: study protocol and rationale for the HYDRO-PROTECT randomized controlled trial

Dietary Aspects and Drug-Related Side Effects in Autosomal Dominant Polycystic Kidney Disease Progression

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