Baseline Characteristics and Patient-Reported Outcomes of ADPKD Patients in the Multicenter TAME-PKD Clinical Trial

Abstract

Background: Autosomal dominant polycystic kidney disease (ADPKD) has been associated with metabolic disturbances characterized by downregulation of AMP-activated protein kinase (AMPK), a critical sensor of the cellular energy status. Therapeutic activation of AMPK by metformin could inhibit cyst enlargement by inhibition of both the mammalian target of rapamycin pathway and fluid secretion via the CFTR chloride channel.

Methods: We designed a phase-2, randomized, placebo-controlled, clinical trial to assess the safety, tolerability, and efficacy of metformin on total kidney volume in adults without diabetes (age 18-60 years) with ADPKD and eGFR of ≥50 ml/min per 1.73 m2. There were no eligibility criteria relating to kidney volume. In addition to demographics and clinical/family history, baseline parameters included eGFR, total kidney and liver volumes measured by MRI, and patient-reported outcomes were ascertained by the Medical Outcomes Study Short Form-36, the Gastrointestinal Safety Rating Scale, and the HALT-PKD pain questionnaire.

Results: We successfully randomized 97 participants recruited from two university-based clinical sites in Baltimore and Boston. The mean age of participants was 41.9 years, 72% were female, and 94% of participants were White. The majority of study participants had early stage disease, with a mean eGFR of 86.8±19.0 ml/min per 1.73 m2. Approximately half of the study participants (48%) were classified as high risk for progression (Mayo imaging classes 1C, 1D, or 1E). There was no correlation between kidney and/or liver size and health-related quality of life (HRQoL) or gastrointestinal symptom severity.

Conclusions: We report successful recruitment in this ongoing, novel, clinical trial of metformin in ADPKD, with a study sample comprising patients with early stage disease and nearly a half of participants considered at high estimated risk for progression. Participants reported a low gastrointestinal symptom burden at baseline, and HRQoL similar to that of the general population, with no differences in symptoms or HRQoL related to organomegaly.

Clinical trial registry name and registration number: Metformin as a Novel Therapy for Autosomal Dominant Polycystic Kidney Disease (TAME), NCT02656017.

Conflict of interest statement

K. Bae is a consultant to Kadmon Corporation, Otsuka, and Sanofi. R. Perrone is a consultant to Otsuka, Palladiobio, Reata, Sanofi-Genzyme, and Vertex. R. Perrone serves as the editor of the renal cystic disease section for UpToDate. T. Watnick has a patent to Athena Diagnostics issued, is on the scientific advisory committee of the PKD Foundation (no financial relationship), serves in an advisory capacity as chair of the advisory committee to the PKD Foundation’s ADPKD registry (no financial relationship). All remaining authors have nothing to disclose.

Figures

Graphical abstract

Figure 1.

Flow of participants from screening to randomization. NOS, not otherwise specified; MRI, magnetic resonance imaging.

Figure 2.

Height-adjusted kidney volume was not associated with health-related quality of life. (A) Short Form-36 (SF-36) mental composite score (MCS) and height-adjusted total kidney volume (htTKV). (B) SF-36 physical composite score (PCS) and htTKV.