Predicting Progression to Kidney Failure in Patients With ADPKD

Patients with autosomal dominant polycystic kidney disease (ADPKD) commonly progress to end-stage renal disease (kidney failure) in the fifth decade of life. According to researchers, led by Alan S L Yu, there is a significant unmet need for an accurate prognostic model that can predict the course of ADPKD early in individual patients.

CRISP IV is the longest existing ADPKD cohort (21 years), providing an opportunity to identify the association between clinical observations early in the disease and hard clinical outcomes. Data were collected from participants in the CRISP and HALT-A studies between 2001 and 2022. Multivariable Cox proportional hazards models were used in data analysis.

The outcome of interest was a composite of kidney failure, defined as the need for dialysis or kidney transplant, and estimated glomerular filtration rate <15 mL/min/1.73 m². Candidate dependent variables were selected on the basis of face validity, and included in the model via iterative forward selection.

The analysis included data on 759 participants. Median follow-up was 8.2 years. During follow-up, 16.2% of the cohort (n=123) reached the composite endpoint. A prognostic model was built using five essential variables. Four clinical variables were found to add independently to the model: serum CO₂, hemoglobin, body mass index, and diastolic blood pressure.

“We have developed a prognostic model that can predict kidney failure in an ADPKD patient over a time horizon of 15 years,” the researchers said. “The next step is to validate this in an external ADPKD registry cohort and create a risk calculator.”

Source: Yu ASL, Cohen A, Ables E, et al. Prognostic model for progression of autosomal dominant polycystic kidney disease to kidney failure. TH-PO427. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2023; November 2, 2023; Philadelphia, Pennsylvania.