Résumé
Purpose: The purpose of this article is to update the previously published consensus recommendations from March 2017 discussing the optimal management of adult patients with autosomal dominant polycystic kidney disease (ADPKD). This document focuses on recent developments in genetic testing, renal imaging, assessment of risk regarding disease progression, and pharmacological treatment options for ADPKD. Sources of information: Published literature was searched in PubMed, the Cochrane Library, and Google Scholar to identify the latest evidence related to the treatment and management of ADPKD. Methods: All pertinent articles were reviewed by the authors to determine if a new recommendation was required, or if the previous recommendation needed updating. The consensus recommendations were developed by the authors based on discussion and review of the evidence. Key findings: The genetics of ADPKD are becoming more complex with the identification of new and rarer genetic variants such as GANAB. Magnetic resonance imaging (MRI) and computed tomography (CT) continue to be the main imaging modalities used to evaluate ADPKD. Total kidney volume (TKV) continues to be the most validated and most used measure to assess disease progression. Since the publication of the previous consensus recommendations, the use of the Mayo Clinic Classification for prognostication purposes has been validated in patients with class 1 ADPKD. Recent evidence supports the benefits of a low-osmolar diet and dietary sodium restriction in patients with ADPKD. Evidence from the Replicating Evidence of Preserved Renal Function: an Investigation of Tolvaptan Safety and Efficacy in ADPKD (REPRISE) trial supports the use of ADH (antidiuretic hormone) receptor antagonism in patients with ADPKD 18 to 55 years of age with eGFR (estimated glomerular filtration rate) of 25 to 65 mL/min/1.73 m2 or 56 to 65 years of age with eGFR of 25 to 44 mL/min/1.73 m2 with historical evidence of a decline in eGFR >2.0 mL/min/1.73 m2/year. Limitations: Available literature was limited to English language publications and to publications indexed in PubMed, the Cochrane Library, and Google Scholar. Implications: Advances in the assessment of the risk of disease progression include the validation of the Mayo Clinic Classification for patients with class 1 ADPKD. Advances in the pharmacological management of ADPKD include the expansion of the use of ADH receptor antagonism in patients 18 to 55 years of age with eGFR of 25 to 65 mL/min/1.73 m2 or 56 to 65 years of age with eGFR of 25 to 44 mL/min/1.73 m2 with historical evidence of a decline in eGFR >2.0 mL/min/1.73 m2/year, as per the results of the REPRISE study.
| Langue d'origine | English |
|---|---|
| Journal | Canadian Journal of Kidney Health and Disease |
| Volume | 5 |
| DOI | |
| Statut de publication | Published - oct. 1 2018 |
Note bibliographique
Funding Information:The authors gratefully acknowledge the contribution of Angela Styhler in the drafting of the article. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Otsuka, the funding sponsor, offered unrestricted support to the development of these recommendations and did not have any part in creating this document. Funding sponsor representatives were not present at the meeting. The meeting that produced the recommendations presented was organized by SNELL Medical Communication. Honoraria were provided to the participants to review select articles and attend a meeting to discuss and provide expert opinion on the topics contained herein. The funding also provided the authors with the services of an experienced and qualified medical writer to ensure a professional article. The medical writer, solely under the direction and outline of the authors, assisted in researching the topic and preparing the article draft.
Funding Information:
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Steven Soroka reports receiving honoraria for lecturing on autosomal dominant polycystic kidney disease (ADPKD), and developing educational material and participating in advisory boards from Otsuka Canada. Dr Daniel G. Bichet reports receiving honoraria for lectures on ADPKD and grants from Otsuka Canada, grants from Otsuka US to conduct trials, and Otsuka Europe for lectures and consultancies on ADPKD. Dr Ahsan Alam reports receiving honoraria for consultancy and lecturing from Otsuka Canada and Amgen. Dr Louis-Philippe Girard reports receiving honoraria for his involvement in continuing medical education and his participation in advisory boards from Otsuka Canada. Dr Philip McFarlane reports receiving honoraria for his participation in advisory boards from Otsuka Canada. Dr Paul Tam reports receiving a research grant from Janssen and honoraria for his participation in advisory boards from Amgen. Dr. Sanjaya Pandeya reports receiving honoraria for participation in advisory boards, consultancy, and lecturing from Otsuka Canada. Dr Micheli Bevilacqua discloses that he has received honoraria for consultancy, lecturing, and participation in advisory boards, as well as a research grant from Otsuka Canada. Drs Paul Komenda and Rolf Loertscher have no disclosures to report regarding their contributions to this article.
Publisher Copyright:
© The Author(s) 2018.
ASJC Scopus Subject Areas
- Nephrology