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).