Epidemiological study of kidney survival in autosomal dominant polycystic kidney disease.
BACKGROUND
It is unknown whether the substantial increase in research, identification of risk factors for renal progression, greater antihypertensive armamentarium including inhibitors of the renin-angiotensin-aldosterone system (RAAS) and enhanced educational information have impacted the progression of autosomal dominant polycystic kidney disease (ADPKD) renal disease.


METHODS
An epidemiological study involving 513 ADPKD subjects was performed. The hypothesis tested was that over two separate periods, 1985 to 1992 versus 1992 to 2001, a significant slowing of renal function loss in ADPKD patients would be demonstrated in association with improved blood pressure (BP) control and inhibition of the RAAS as instituted by their primary care physicians.


RESULTS
ADPKD males and females in the later cohort (1992 to 2001) had longer mean and median survival times to ESRD than males and females in the earlier cohort (1985 to 1992). Analysis revealed that both males and females in the later cohort had significantly lower diastolic blood pressure (DBP) and mean arterial pressure (MAP) values than males and females in the earlier cohort. ADPKD male and female patients in the later cohort used significantly more angiotensin converting enzyme inhibitors (ACEIs) than ADPKD male and female patients in the earlier cohort.


CONCLUSIONS
These results demonstrate a significant slowing of ADPKD renal progression in both male and female patients that was associated with a significantly lower MAP and increased use of ACEIs in the later cohort (1992 to 2001) as compared to the early cohort (1985-1992).
Schrier
Robert W
RW
Department of Medicine, University of Colorado School of Medicine, Denver, Colorado 80262, USA. Robert.Schrier@ucshc.edu
McFann
Kimberly K
KK
Johnson
Ann M
AM
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001794:Blood Pressure; D015331:Cohort Studies; D003971:Diastole; D018450:Disease Progression; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications / Q000503:physiopathology*; D016019:Survival Analysis; D014022:Tissue Survival
D000806:Angiotensin-Converting Enzyme Inhibitors