Prescribed Water Intake in Autosomal Dominant Polycystic Kidney Disease
Rangan GK, Wong ATY, Munt A, Zhang JQJ, Saravanabavan S, Louw S, Allman-Farinelli M, Badve SV, Boudville N, Chan J, Coolican H, Coulshed S, Edwards ME, Erickson BJ, Fernando M, Foster S, Gregory AV, Haloob I, Hawley CM, Holt J, Howard K, Howell M, Johnson DW, Kline TL, Kumar K, Lee VW, Lonergan M, Mai J, McCloud P, Pascoe E, Peduto A, Rangan A, Roger SD, Sherfan J, Sud K, Torres VE, Vilayur E, Harris DCH
NEJM evidence · 47 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Randomized controlled trial (indexed by PubMed)
- Studied in
- People
- Main outcome
- Health markers and function
Who paid for it
- Funding
- Funding not disclosed
Publication
- Published
- 2021-12-21 · NEJM Evid · vol. 1 · issue 1 · p. EVIDoa2100021
- Cited
- 57 citations · more than 97% of similar papers · 5.4× the field average
- Impact
- Top 10% most cited in its field
- References
- 39 works
- Access
- Paywalled
- Research areas
- Genetic and Kidney Cyst Diseases · Pediatric Urology and Nephrology Studies · Renal and related cancers
- Keywords
- Urine osmolality, Medicine, Autosomal dominant polycystic kidney disease, Renal function, Urine, Vasopressin, Kidney disease, Urine specific gravity, Confidence interval, Internal medicine, Kidney, Plasma osmolality, Urology, Polycystic kidney disease, Endocrinology, Animal science, Biology
- MeSH
- kidney, humans, polycystic kidney, autosomal dominant, drinking, adult, middle aged, female, male
38 authors
From AU, US
- Gopala K. RanganThe University of Sydney; Westmead Hospital; Sydney Local Health District; Westmead Institute for Medical Research; Western Sydney Local Health District
- Annette T. Y. WongThe University of Sydney; Westmead Hospital; Sydney Local Health District; Westmead Institute for Medical Research; Western Sydney Local Health District
- Alexandra MuntThe University of Sydney; Westmead Hospital; Sydney Local Health District; Westmead Institute for Medical Research; Western Sydney Local Health District
- Jennifer Q. J. ZhangThe University of Sydney; Westmead Hospital; Sydney Local Health District; Westmead Institute for Medical Research; Western Sydney Local Health District
- Sayanthooran SaravanabavanThe University of Sydney; Westmead Hospital; Sydney Local Health District; Westmead Institute for Medical Research; Western Sydney Local Health District
- Sandra Louw
Abstract
BACKGROUND: Arginine vasopressin promotes kidney cyst growth in autosomal dominant polycystic kidney disease (ADPKD). Increased water intake reduces arginine vasopressin and urine osmolality and may slow kidney cyst growth. METHODS: In this randomized controlled 3-year clinical trial, we randomly assigned adults with ADPKD who had a height-corrected total kidney volume in Mayo imaging subclass categories 1B to 1E and an estimated glomerular filtration rate of 30 ml/min/1.73 m2 or greater to (1) water intake prescribed to reduce 24-hour urine osmolality to 270 mOsmol/kg or less or (2) ad libitum water intake irrespective of 24-hour urine osmolality. The primary end point was the percentage annualized rate of change in height-corrected total kidney volume. RESULTS: A total of 184 patients participated in either the ad libitum water intake group (n=92) or the prescribed water intake group (n=92). Over 3 years, there was no difference in the annualized rate of change in height-corrected total kidney volume between the ad libitum (7.8% per year; 95% confidence interval [CI], 6.6 to 9.0) and prescribed (6.8% per year; 95% CI, 5.8 to 7.7) water intake groups (mean difference, −0.97% per year; 95% CI, −2.37 to 0.44; P=0.18). The difference in mean 24-hour urine osmolality between the ad libitum and prescribed water intake groups was −91 mOsmol/kg (95% CI, −127 to −54 mOsmol/kg), with 52.3% of patients achieving adherence to the target 24-hour urine osmolality and no reduction in serum copeptin over 3 years. The frequency of adverse events was similar between groups. CONCLUSIONS: For patients with ADPKD, prescribed water intake was not associated with excess adverse events and achieved the target 24-hour urine osmolality for half of the patients but did not reduce copeptin or slow the growth of total kidney volume over 3 years compared with ad libitum water intake. (Funded by the National Health and Medical Research Council of Australia [grant GNT1138533], Danone Research, PKD Australia, the University of Sydney, and the Westmead Medical Research Foundation; Australian New Zealand Clinical Trials Registry number, ACTRN12614001216606).
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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