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Sagar PS, Rangan GK. Cardiovascular Manifestations and Management in ADPKD. Kidney Int Rep 2023; 8:1924-1940. [PMID: 37850017 PMCID: PMC10577330 DOI: 10.1016/j.ekir.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/27/2023] [Accepted: 07/24/2023] [Indexed: 10/19/2023] Open
Abstract
Cardiovascular disease (CVD) is the major cause of mortality in autosomal dominant polycystic kidney disease (ADPKD) and contributes to significant burden of disease. The manifestations are varied, including left ventricular hypertrophy (LVH), intracranial aneurysms (ICAs), valvular heart disease, and cardiomyopathies; however, the most common presentation and a major modifiable risk factor is hypertension. The aim of this review is to detail the complex pathogenesis of hypertension and other extrarenal cardiac and vascular conditions in ADPKD drawing on preclinical, clinical, and epidemiological evidence. The main drivers of disease are the renin-angiotensin-aldosterone system (RAAS) and polycystin-related endothelial cell dysfunction, with the sympathetic nervous system (SNS), nitric oxide (NO), endothelin-1 (ET-1), and asymmetric dimethylarginine (ADMA) likely playing key roles in different disease stages. The reported rates of some manifestations, such as LVH, have decreased likely due to the use of antihypertensive therapies; and others, such as ischemic cardiomyopathy, have been reported with increased prevalence likely due to longer survival and higher rates of chronic disease. ADPKD-specific screening and management guidelines exist for hypertension, LVH, and ICAs; and these are described in this review.
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Affiliation(s)
- Priyanka S. Sagar
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
- Department of Renal Medicine, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, New South Wales, Australia
| | - Gopala K. Rangan
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
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Akpinar TS, Kucukdagli P, Ozer PK, Karaayvaz EB, Ince B, Bakkaloglu OK, Sarihan I, Medetalibeyoglu A, Altinkaynak M, Uzun DD, Bozbora E, Kose M, Ecder T, Yazici H. Subclinic arterial and left ventricular systolic impairment in autosomal dominant polycystic kidney disease with preserved renal functions. Int J Cardiovasc Imaging 2021; 38:271-278. [PMID: 34436702 DOI: 10.1007/s10554-021-02389-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Indexed: 11/24/2022]
Abstract
Subclinical atherosclerosis and cardiovascular events are common even in young normotensive patients with autosomal dominant polycystic kidney disease (ADPKD). Our aim was to examine the relationship between serum fibroblast growth factor-23 (FGF-23) levels, left ventricular global longitudinal strain (LV-GLS), arterial stiffness (AS), and carotid intima-media thickness (CIMT) in patients with ADPKD with preserved kidney function. The relationship between albuminuria, AS, LV-GLS, CIMT, 24-hour ambulatory blood pressure measurement, and FGF-23 was examined in 52 normotensive and hypertensive patients with ADPKD and a matched control group of 35 subjects. AS was assesed with brachial-ankle pulse wave velocity, LV-GLS was measured with speckle-tracking echocardiography. FGF-23 was measured with enzyme-linked immunosorbent assay. The microalbumin/creatinine ratio was significantly higher in the ADPKD group than in the control group (p?<?0.001). Serum FGF-23 levels were similar between the study and control group. LV-GLS value tended to be impaired and CIMT to be higher in the ADPKD group compared to controls (?18.1?±?2.6 vs. -19.4?±?3.1?%, p?=?0.08; 0.75?±?0.1 vs. 0.68?±?0.1 mm, p?=?0.09, respectively). The augmentation index was significantly higher in the ADPKD group than in the control group (26.2?±?12.5 vs. 16.4?±?11.2 mmHg/mmHg, p?=?0.01). Our study supports subclinical impairment in arterial and cardiac functions in the early period of ADPKD. However, none of these factors was found to be associated with serum FGF-23 levels.
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Affiliation(s)
- Timur Selcuk Akpinar
- Istanbul Medical Faculty, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Pinar Kucukdagli
- Istanbul Medical Faculty, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Pelin Karaca Ozer
- Istanbul Medical Faculty, Department of Cardiology, Istanbul University, Istanbul, Turkey. .,Faculty of Medicine, Department of Cardiology, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, Fatih/Istanbul, 34093, Turkey.
| | - Ekrem Bilal Karaayvaz
- Istanbul Medical Faculty, Department of Cardiology, Istanbul University, Istanbul, Turkey
| | - Burak Ince
- Istanbul Medical Faculty, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Oguz Kagan Bakkaloglu
- Istanbul Medical Faculty, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Irem Sarihan
- Istanbul Medical Faculty, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Alpay Medetalibeyoglu
- Istanbul Medical Faculty, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Altinkaynak
- Istanbul Medical Faculty, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Duygu Derya Uzun
- Istanbul Medical Faculty, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Erol Bozbora
- Istanbul Medical Faculty, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Kose
- Istanbul Medical Faculty, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Tevfik Ecder
- Istanbul Medical Faculty, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Istanbul Medical Faculty, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
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