Predicting Future Renal Function Decline in Patients with Autosomal Dominant Polycystic Kidney Disease Using Mayo Clinic Classification

Utiel, Francisco José Borrego; Rosa, Rafael José Esteban de la; García, Enoc Merino; Benítez, Antonio Medina; Moyano, Aurora Polo; Domínguez, Clara Moriana; García, Ana Isabel Morales; Soto, Juan Antonio Bravo

doi:10.1159/000518255

Cited by 7 publications

(8 citation statements)

References 19 publications

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“…Currently, the most accepted predictor of RP is the MCC ( 16 , 17 ), as it has been shown to be the best predictor tool regardless of the CKD stage ( 17 , 18 ). In our study, 95.6% of the included patients belonged to classes 1C to 1E of MCC.…”

Section: Discussionmentioning

confidence: 99%

Real clinical experience after one year of treatment with tolvaptan in patients with autosomal dominant polycystic kidney disease

et al. 2022

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BackgroundTolvaptan (TV) is the first vasopressin-receptor antagonist approved for the treatment of autosomal dominant polycystic kidney disease (ADPKD). No publications report TV experience in real clinical practice during the first year of treatment.MethodsA prospective study of an initial cohort of 220 rapidly progressing patients treated with TV for 12 months. The tolerability of TV, the evolution of the estimated glomerular filtration rate (eGFR), analytical parameters, and blood pressure were analyzed.ResultsA total of 163 patients (78.2%) received TV for 1 year. The main causes of treatment withdrawal were the aquaretic effects (11%), eGFR deterioration (5%), and hepatic toxicity (2.3%). eGFR decreased significantly after 1 month of treatment without further changes. The decrease in eGFR in the first month was higher in patients with an initially higher eGFR. The eGFR drop during the first year of treatment with TV was lower than that reported by patients in the 2 years prior to TV treatment (–1.7 ± 7.6 vs. –4.4 ± 4.8 mL/min, p = 0.003). Serum sodium and uric acid concentrations increased, and morning urinary osmolality decreased in the first month, with no further changes. Blood pressure decreased significantly without changes in antihypertensive medication.ConclusionTV treatment is well tolerated by most patients. Liver toxicity is very rare and self-limited. TV reduces eGFR in the first month without showing further changes during the first year of treatment. Patients with a higher starting eGFR will suffer a greater initial drop, with a longer recovery. We suggest using the eGFR observed after a month of treatment as the reference for future comparisons and calculating the rate of eGFR decline in patients undergoing TV treatment.

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Section: Discussionmentioning

confidence: 99%

Real clinical experience after one year of treatment with tolvaptan in patients with autosomal dominant polycystic kidney disease

et al. 2022

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“…While previous studies 4,24 have proposed polynomial models using age together with Mayo HtTKV class or mutation type to predict kidney function trajectories in ADPKD, we chose to retain baseline eGFR as a predictor variable due to its robust association with future eGFR. 25 However, like prior polynomial models, the precision of our model is limited, as shown by the CIs of the prediction error at follow-up (Supplemental Figure 5). This indicates that there is an ongoing challenge in developing predictive models that not only yield accurate average results for subgroups but also provide more precise predictions for individual patients.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Mayo Imaging Classification System for Predicting Kidney Outcomes in ADPKD

Bais,

Geertsema,

Knol

et al. 2024

CJASN

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Background: The Mayo Imaging Classification (MIC) was developed to predict the rate of disease progression in patients with autosomal dominant polycystic kidney disease (ADPKD). This study aimed to validate its ability to predict kidney outcomes in a large multicenter ADPKD cohort. Methods: Included were patients with ≥1 height-adjusted total kidney volume (HtTKV) measurement and ≥3 estimated glomerular filtration rate (eGFR) values during ≥1 year follow-up. Mayo HtTKV class stability, kidney growth rates and eGFR decline rates were calculated. The observed eGFR decline was compared to predictions from the Mayo Clinic future eGFR equation. The future eGFR prediction equation was also tested for non-linear eGFR decline. Kaplan-Meier survival analysis and Cox regression models were used to assess time to kidney failure using Mayo HtTKV class as a predictor variable. Results: We analyzed 618 patients with a mean age of 47 ± 11 years and mean eGFR of 64 ± 25 ml/min/1.73m2 at baseline. Most patients (82%) remained in their baseline Mayo HtTKV class. During a mean follow-up of 5.1 ± 2.2 years, the mean TKV growth rates and eGFR decline were 5.33 ± 3.90 %/year and -3.31 ± 2.53 ml/min/1.73m2/year, respectively. Kidney growth and eGFR decline showed considerable overlap between the classes. The observed annual eGFR decline was not significantly different from the predicted values for classes 1A, 1B, 1C, and 1D but significantly slower for class 1E. This was also observed in patients aged <40 and >60 years and those with PKD2 mutations. A polynomial model allowing non-linear eGFR decline provided more accurate slope predictions. Ninety-seven patients (16%) developed kidney failure during follow-up. The classification predicted the development of kidney failure, although the sensitivity and positive predictive values were limited. Conclusion: The MIC demonstrated acceptable stability and generally predicted kidney failure and eGFR decline rate. However, there was marked interindividual variability in the rate of disease progression within each class.

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“…Even with these small drawbacks, MCC has been validated as a prognostic marker of future GFR decline in several populations 22–24 and has provided valuable and practical information in post hoc analysis of TEMPO 3:4 25 and HALT-polycystic kidney disease studies, 26 compared with other existing models that showed to be less applicable to clinical practice. 29 For example, application of MCC model to TEMPO 3:4 and TEMPO 4:4 studies showed that groups of patients in which tolvaptan showed clearer benefit were 1C, 1D, and 1E MCC classes, corresponding to those who underwent faster growth.…”

Section: Discussionmentioning

confidence: 99%

“…When curves were conveniently adjusted using Cox regression models including age and baseline GFR, kidney growth rate was found to be an effective predictor of future GFR deterioration in ADPKD. 20,23,24 Furthermore, this model that has been the so-called Mayo Clinic classification (MCC) has shown very interesting results when applied to Tolvaptan Efficacy and Safety in Management of Autosomal Dominant Polycystic Kidney Disease and its Outcomes (TEMPO) 3:4 25 and HALT-polycystic kidney disease studies, 26 clarifying which groups may respond more efficiently to disease-modifying treatments, with evident interest for the design of future clinical trials.…”

Section: Introductionmentioning

confidence: 99%

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How to Estimate Kidney Growth in Patients with Autosomal Dominant Polycystic Kidney Disease

Utiel

Hernández

2023

JASN

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Autosomal dominant polycystic kidney disease (ADPKD) is a disease characterized by a progressive kidney growth due to the development of cysts that lead to gradual destruction of the surrounding parenchyma. In the first stage, the estimated GFR will remain stable despite the reduction of the renal parenchyma because of an increase in glomerular hyperfiltration. The total kidney volume (TKV) measured with computed tomography or magnetic resonance imaging is related to the future GFR decline. Thus, TKV has become an early marker to be analyzed in all patients with ADPKD. In addition, in recent years, it has been pointed out that kidney growth rate estimated with a single TKV measurement can be a clear prognostic marker for future glomerular filtration decline. However, there is no consensus on how to measure kidney volume growth in ADPKD, so each author has used different models that, not having the same meaning, have been handled as if they produced similar values. This may lead to erroneous estimates of kidney growth rate with the consequent prognostic error. The Mayo Clinic classification is now the most widely accepted prognostic model in clinical practice to predict patients who will deteriorate faster and to decide what patients should be treated with tolvaptan. However, some aspects of this model have not been discussed in depth. Our aim in this review was to present the models that can be used to estimate kidney volume growth rate in ADPKD, to facilitate their applicability in daily clinical practice.

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Predicting Future Renal Function Decline in Patients with Autosomal Dominant Polycystic Kidney Disease Using Mayo Clinic Classification

Cited by 7 publications

References 19 publications

Real clinical experience after one year of treatment with tolvaptan in patients with autosomal dominant polycystic kidney disease

Real clinical experience after one year of treatment with tolvaptan in patients with autosomal dominant polycystic kidney disease

Validation of the Mayo Imaging Classification System for Predicting Kidney Outcomes in ADPKD

How to Estimate Kidney Growth in Patients with Autosomal Dominant Polycystic Kidney Disease

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