Fast Five Quiz: Autosomal Dominant Polycystic Kidney Disease Management

Neera K. Dahl, MD, PhD

Disclosures

July 01, 2021

Figure 1. Colored coronal abdominal MRI showing a patient's polycystic left kidney (red/black, upper right). The kidney is enlarged by the presence of many cysts (black). The normal kidney shape is shown by the right kidney (orange, upper left), which sits below the liver (green). The spine, consisting of alternating vertebrae (blocks, brown) and intervertebral discs (dark blue), runs down the center of the image.

Dietary salt restriction has been shown to be beneficial in the management of ADPKD and is recommended for all patients with ADPKD. For example, the CRISP trial showed an association between urine sodium excretion, a surrogate marker for dietary sodium, and the rate of increase in total kidney volume (TKV) at comparatively early stages of the disease. Increased urinary sodium was associated with accelerated cyst growth. Serum high-density lipoprotein cholesterol, urine sodium excretion, and 24-hour urine osmolality were also shown to affect TKV. In the HALT-PKD trial, dietary sodium was significantly associated with TKV increase (study A) or estimated glomerular filtration rate (eGFR) decline (study B), whereas higher potassium intake was associated with less TKV increase (study A) or eGFR decline (study B).

A low-protein diet has not been shown to slow the rate of ADPKD progression and may in fact increase the risk for malnutrition. The Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference on ADPKD did not endorse any specific protein intake for patients with ADPKD and instead referred clinicians to the 2012 KDIGO guideline on CKD, which recommends lowering protein intake to 0.8 g/kg/d when the eGFR is < 30 mL/min/1.73 m2.

Although some authors have advocated for moderately enhanced fluid intake among patients with ADPKD, the currently available evidence does not suggest that high fluid intake is beneficial for reducing cyst growth in ADPKD. Two ongoing or recently completed water intake trials — the DRINK feasibility trial and the PREVENT-ADPKD trial — are expected to help illuminate the feasibility, compliance, and impact of efforts at increasing water intake among patients with ADPKD.

Learn more about the management of ADPKD.

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