Longitudinal Assessment of Left Ventricular Mass in Autosomal Dominant Polycystic Kidney Disease

Abstract

IntroductionThe high burden of cardiovascular morbidity and mortality in autosomal dominant polycystic kidney disease (ADPKD) is related to development of hypertension and left ventricular hypertrophy. Blood pressure reduction has been shown to reduce left ventricular mass in ADPKD; however, moderators and predictors of response to lower blood pressure are unknown.MethodsThis was a post hoc cohort analysis of HALT PKD study A, a randomized placebo controlled trial examining the effect of low blood pressure and single versus dual renin−angiotensin blockade in early ADPKD. Participants were hypertensive ADPKD patients 15 to 49 years of age with estimated glomerular filtration rate (eGFR) > 60 ml/min per 1.73 m2 across 7 centers in the United States. Predictors included age, sex, baseline eGFR, systolic blood pressure, total kidney volume, serum potassium, and urine sodium, potassium, albumin, and aldosterone. Outcome was left ventricular mass index (LVMI) measured using 1.5-T magnetic resonance imaging at months 0, 24, 48, and 60.ResultsReduction in LVMI was associated with higher baseline systolic blood pressure and larger kidney volume regardless of blood pressure control group assignment (P < 0.001 for both). Male sex and baseline eGFR were associated with a positive annual slope in LVMI (P < 0.001 and P = 0.07, respectively).ConclusionCharacteristics associated with higher risk of progression in ADPKD, including higher systolic blood pressure, larger kidney volume, and lower eGFR are associated with improvement in LVMI with intensive blood pressure control, whereas male sex is associated with a smaller slope of reduction in LVMI.

Left ventricular hypertrophy in a contemporary cohort of autosomal dominant polycystic kidney disease patients

“…Such activation may lead to adverse cardiac remodeling through both blood pressure-dependent and pressure-independent mechanisms. Pharmacological blockade of the RAAS can lead to regression or improvement in LVH in adult and pediatric ADPKD populations [31, 32], including a recent report by Dad et al showing that intensive blood pressure control can lead to reduction of LVMI, especially in patients with higher baseline BP measurements [33]. Of note, in the present study, nearly 2/3 rds of participants were on current treatment with RAAS inhibitors.…”

Clinical findings, underlying pathogenetic processes and treatment of vascular dysfunction in autosomal dominant polycystic kidney disease

“…Hypertension is one of the most common cardiovascular diseases in patients with ADPKD, with approximately 60% of patients developing hypertension [ 29 ]. Due to long-term hypertension and impaired renal function, the heart of ADPKD patients is subjected to a greater load, leading to left ventricular hypertrophy, which may lead to serious consequences such as arrhythmias and heart failure (HF) [ 53 ]. Heart failure caused by myocardial damage, reduced cardiac function, and other reasons may lead to symptoms such as dyspnea, edema, fatigue, and even life-threatening conditions [ 54 ].…”

The Pathophysiology of Left Ventricular Hypertrophy, beyond Hypertension, in Autosomal Dominant Polycystic Kidney Disease

“…Rigorous blood pressure versus standard blood pressure control resulted in a slower increase in total kidney volume and no overall change in the estimated glomerular filtration rate. However, rigorous blood pressure control resulted in a greater decline in the LVMI and a greater reduction in urinary albumin excretion, suggesting that there is indeed LVH that could be improved with intensive blood pressure control [11, 12].…”