Kidney volume and function in autosomal dominant polycystic kidney disease

Eiji Higashihara, Kikuo Nutahara, Takatsugu Okegawa, Toshihide Shishido, Mitsuhiro Tanbo, Kuninori Kobayasi, Toshiaki Nitadori, Eiji Higashihara, Kikuo Nutahara, Takatsugu Okegawa, Toshihide Shishido, Mitsuhiro Tanbo, Kuninori Kobayasi, Toshiaki Nitadori

Abstract

Background: The significance of total kidney volume (TKV) as a biomarker of kidney function in autosomal dominant polycystic kidney disease (ADPKD) is controversial and has been reappraised.

Methods: Between 2007 and 2012, 64 patients were followed with a mean 39.7-month observation period. TKV measurements by magnetic resonance imaging and estimation of renal function with estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation and 24-h urine creatinine clearance were repeated annually.

Results: TKV and its adjusted parameters (height-adjusted, body surface area-adjusted and log-converted TKV [log-TKV]) correlated with eGFR significantly. Among them, the correlation coefficient of log-TKV was most significant (r = -0.6688, p < 0.001). The eGFR slope correlated negatively with TKV slope (p < 0.05). TKV increased faster and became larger as chronic kidney disease (CKD) stage advanced. As age advanced, eGFR declined significantly (p < 0.001), but the eGFR slope remained constant. There was no significant correlation between TKV and age, but the log-TKV slope became smaller as age advanced. If baseline TKV was large, the eGFR slope was steeper (p < 0.05), which suggests that eGFR declines faster in patients with larger kidney volume.

Conclusions: TKV is confirmed as a clinically meaningful surrogate marker in ADPKD. Log-TKV correlates with eGFR most significantly. Higher rates of kidney enlargement and larger kidney volume are associated with a more rapid decrease in kidney function. Kidney function decreased faster as CKD stage advanced, but its declining slope did not change significantly by age, at least after ~30 years of age.

Figures

Fig. 1
Fig. 1
Correlation of a total kidney volume (TKV), b height-adjusted TKV (ht-TKV), c body surface area-adjusted TKV (bs-TKV) and d log-converted TKV (log-TKV) to estimated glomerular filtration rate (eGFR). These values are final measurements. The correlation coefficients (r) of all TKV-related parameters are significant. Among them, r of log-TKV is most significant
Fig. 2
Fig. 2
a Correlation coefficient (r) between baseline TKV and eGFR slope is significant (p = 0.0349). b The correlation coefficient (r) between TKV slope and eGFR slope is significant (p = 0.0385)
Fig. 3
Fig. 3
Individual TKV data and the age at measurement are plotted and connected according to chronic kidney disease (CKD) stages. Finally measured eGFR was used to indicate the CKD stage category
Fig. 4
Fig. 4
a Correlation coefficient (r) between eGFR and age is highly significant. Age and eGFR are those measured at the final time. b There was no significant correlation coefficient (r) between age and the slope of eGFR. Age is at the final measurement
Fig. 5
Fig. 5
The correlation coefficients (r) between age and TKV a and between age and log-TKV b are not significant. c The TKV slope tends to decrease as age advances, but r between age and TKV slope is not significant. d The log-TKV slope decreased significantly as age increased. The r between age and log-TKV slope is significant (p < 0.01). Age, TKV and log-TKV are final measurements

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