ADPKD and Subclinical Metabolic Abnormalities

Austin—Patients with autosomal dominant polycystic kidney disease (ADPKD) experience high lifetime morbidity, related to both renal sequelae and to cardiovascular risk. Recent studies have identified abnormal regulation of pathways affecting cellular signaling, proliferation, and apoptosis in patients with ADPKD. Future targets for treatment may include modifying factors related to abnormal lipid metabolism, insulin insensitivity, early hypertension, as well as other risk factors for left ventricular hypertrophy and cardiovascular morbidity.

According to Diana Mina, MD, and colleagues, many of the abnormalities “are often unrecognized.” In addition, there is no standard approach to screening for these factors in patients with ADPKD. Dr. Mina et al. recently conducted a review to determine the availability of clinical data on metabolic abnormalities in patients with ADPKD at the University of California-San Francisco Polycystic Kidney Disease Center of Excellence who consented to participation in the study. Study results were reported during a poster session at the NKF 2018 Spring Clinical Meetings in a poster titled Review of Clinical Data of Patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) for Subclinical Metabolic Abnormalities.

A total of 115 patients were identified; of those, 83 had at least one metabolic measurement available. Mean age of eligible patients was 49 years. Of patients with documented fasting plasma glucose, 31% had pre-diabetes, a prevalence similar to that in the general population. When classified by hemoglobin A1c, 28.6% of ADPKD patients had prediabetes, compared with 12.4% of patients in the general population. One-third of the patients in the analysis had hypertriglyceridemia (>150 mg/d), a prevalence similar to that in the general population.  Approximately 19% had a triglyceride-to-high-density-lipoprotein ratio of >3.5, which is associated with both type 2 diabetes and risk of mortality due to heart disease.

In conclusion, the researchers said, “Metabolic abnormalities significantly contribute to morbidity in ADPKD. Life-long management of these patients provides an opportunity to treat modifiable risk factors. More standardized approaches to assessing metabolic abnormalities in ADPKD patients should be taken.”

Source: Mina D, Roberts M, Park M. Review of clinical data of patients with autosomal dominant polycystic kidney disease (ADPKD) for subclinical metabolic abnormalities. Abstract of a poster presented during the National Kidney Foundation 2018 Spring Clinical Meetings, April 10-14, 2018, Austin, Texas.