Autosomal dominant polycystic kidney disease (ADPKD), the most frequent hereditary renal disease that accounts for approximately 6% to 10% of patients initiating renal replacement therapies worldwide, is not usually associated with diabetic or hypertensive nephropathy. However, there is an increase in the rate of cardiovascular disease (CVD) in patients with ADPKD, with CVD being the first cause of death. Evidence exists that suggests asymptomatic CVD predicts the incidence of cardiovascular events (CVE), but data on evaluation and management of cardiovascular risk in patients with ADPKD are limited.
For a study published in BMC Nephrology, the researchers sought to evaluate the prevalence of classic cardiovascular risk factors in ADPKD, its relationships to asymptomatic CVD, and treatment trends in patients with ADPKD in a large cohort of CKD patients and controls without previous CVD. They evaluated 2,445 patients with CKD for the prevalence of cardiovascular risk factors, the achievement rates for treatment goals, and CVE in ADPKD and their relationship with asymptomatic CVD in CKD from other etiologies and controls.
Patients With ADPKD Had Worse Renal Function
The information collected at baseline and at 24 months included: clinical and anthropometric data, analytical parameters (including renal function, metabolic profiles, anemia, CKD-related mineral bone disease, and inflammation parameters), pharmacological treatments, and the evaluation of CVD using intima-media thickness (IMT), the presence of atheromatous plaque, and ankle-brachial index (ABI). In addition, data on laboratory tests, vital status, CVE, and hospitalizations were collected for 4 years.
To assess the specific impact of ADPKD and exclude the added effect of advanced CKD, a secondary analysis was performed comparing only patients with CKD stage 3 and ADPKD with controls, the study authors note. They compared the adequacy of cardiovascular risk factors control across groups. Blood pressure was considered adequately controlled when it measured less than 140/90 mmHg; cholesterol control was considered adequate when LDL cholesterol was less than 155 mg/dl in non-CKD patients or less than 100 mg/dL in CKD patients.
Controlling Cardiovascular Risk Factors Crucial
“We found that patients with ADPKD showed intermediate control rates of cardiovascular comorbidities, when compared to non-CKD subjects and those with CKD from other etiologies,” the study authors write. “In addition, patients with ADPKD had worse renal function and, when the control of classic cardiovascular risk factors was evaluated, they had the worst achievement of blood pressure targets. They also presented with lower IMT values than other groups, however, an intermediate rate of pathologic ABI and atheromatous plaque was present.”
More than half of the patients received statins, achieving LDL levels of less than 100 mg/dl only in 50% and 39.8% of them (ADPKD and CKD with other etiologies, respectively), according to the study. The researchers note that the number of CVE during the follow-up was low and, in an adjusted Cox regression model, patients with ADPKD had the lowest occurrence of CVE in all three groups.
“Better control of cardiovascular risk factors appears to be associated with a lower burden of CVD, which in the long run, may lead to a better prognosis,” the study authors write. “However, we are still far away from achieving the optimal goals for the control of cardiovascular risk factors in patients with ADPKD. Further investigation is needed to deepen our knowledge about the course of CVD in ADPKD and to determine the usefulness of specific therapeutic measures to improve cardiovascular prognosis in ADPKD.”
Cardiovascular Risk Factors and the Impact on Prognosis in Patients with Chronic Kidney Disease Secondary to Autosomal Dominant Polycystic Kidney Disease