>Other Risk Factors

Other Risk Factors

Overweight and Obesity

Obesity was associated with nearly four times greater adjusted odds of progressing at an annual rate of change in TKV of ≥ 7% compared with < 5%. Obesity was also independently associated with greater eGFR decline (slope) versus normal weight.¹

Four hundred forty-one participants with early ADPKD who participated in HALT-PKD Study A, were included in the analysis of the association of overweight and obesity with change in TKV.
Participants were categorized by baseline BMI*:
- Normal weight: 18.5–24.9 kg/m² (n=192)
- Overweight: 25.0–29.9 kg/m² (n=168)
- Obese: ≥ 30 kg/m² (n=81)
Overweight and obesity was associated with increased odds of annual percent change in TKV ≥ 7% compared with < 5% (overweight: OR, 2.02; 95% CI, 1.15 to 3.56; obese: OR, 3.76; 95% CI, 1.81 to 7.80)+.

Albuminuria and Proteinuria in ADPKD

CRISP cohort provided longitudinal evidence for associations between elevated albumin-to-creatinine ratio (ACR), increased TKV and decreased eGFR2²

Albuminuria

Microalbuminuria is more common than proteinuria, occurring in 35% of ADPKD individuals.²
Direct evidence that reducing albuminuria in ADPKD affects progression to ESKD is not currently available³
- Some evidence that an elevated ACR is a risk factor for progressive disease and should be included in the decision to target lower blood pressures and increase the dose of RAAS inhibitors.³

Proteinuria

Dipstick-detectable proteinuria occurs in <18% with most demonstrating <1 g/24 h.²
Overt proteinuria is uncommon in ADPKD, with only 27% demonstrating 300 mg/d.⁴
Proteinuria >2 g/d is unusual and suggests the presence of another kidney disease.⁴

*BMI was calculated from an adjusted weight removing the contribution of weight of the kidney and liver; +fully adjusted model.

eGFR=estimated glomerular filtration rate; ADPKD=autosomal dominant polycystic kidney disease; TKV=total kidney volume; CI=confidence interval; ESKD=end stage kidney disease; htTKV=height-adjusted total kidney volume; BMI=body mass index; HALT-PKD study= HALT Progression of Polycystic Kidney Disease (HALT-PKD) study; ACR= albumin-to-creatinine ratio; RAAS=Renin-angiotensin-aldosterone system

References:

1. Nowak et al. J Am Soc Nephrol 29: 571–578, 2018.

2. Rizk, D et al. Cystic and Inherited Kidney Diseases American Journal of Kidney Diseases, Vol 42, No 6 (December), 2003: pp 1305-1317.

3. Lanktree MB, et al. New treatment paradigms for ADPKD: moving towards precision medicine. Nat Rev Nephrol. 2017;13(12):750-768.

4. Chapman AB. Autosomal dominant polycystic kidney disease: time for a change? J Am Soc Nephrol. 2007;18(5):1399-407.

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