Prescribed water intake in autosomal dominant polycystic kidney disease

Gopala K. Rangan; Annette T. Y. Wong; Alexandra Munt; Jennifer Q. J. Zhang; Sayanthooran Saravanabavan; Sandra Louw; Margaret Allman-Farinelli; Sunil V. Badve; Neil Boudville; Jessie Chan; Helen Coolican; Susan Coulshed; Marie E. Edwards; Bradley J. Erickson; Mangalee Fernando; Sheryl Foster; Adriana V. Gregory; Imad Haloob; Carmel M. Hawley; Jane Holt; Kirsten Howard; Martin Howell; David W. Johnson; Timothy L. Kline; Karthik Kumar; Vincent W. Lee; Maureen Lonergan; Jun Mai; Philip McCloud; Elaine Pascoe; Anthony Peduto; Anna Rangan; Simon D. Roger; Julie Sherfan; Kamal Sud; Vicente E. Torres; Eswari Vilayur; David C. H. Harris

doi:10.1056/EVIDoa2100021

Prescribed water intake in autosomal dominant polycystic kidney disease

Gopala K. Rangan, Annette T. Y. Wong, Alexandra Munt, Jennifer Q. J. Zhang, Sayanthooran Saravanabavan, Sandra Louw, Margaret Allman-Farinelli, Sunil V. Badve, Neil Boudville, Jessie Chan, Helen Coolican, Susan Coulshed, Marie E. Edwards, Bradley J. Erickson, Mangalee Fernando, Sheryl Foster, Adriana V. Gregory, Imad Haloob, Carmel M. Hawley, Jane HoltKirsten Howard, Martin Howell, David W. Johnson, Timothy L. Kline, Karthik Kumar, Vincent W. Lee, Maureen Lonergan, Jun Mai, Philip McCloud, Elaine Pascoe, Anthony Peduto, Anna Rangan, Simon D. Roger, Julie Sherfan, Kamal Sud, Vicente E. Torres, Eswari Vilayur, David C. H. Harris

Research output: Contribution to journal › Article › peer-review

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).

Original language	English
Article number	EVIDoa2100021
Pages (from-to)	1-13
Number of pages	13
Journal	NEJM evidence
Volume	1
Issue number	1
DOIs	https://doi.org/10.1056/EVIDoa2100021
Publication status	Published - 9 Jan 2022
Externally published	Yes

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10.1056/EVIDoa2100021

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Rangan, G. K., Wong, A. T. Y., Munt, A., Zhang, J. Q. J., Saravanabavan, S., Louw, S., Allman-Farinelli, M., Badve, S. V., Boudville, N., Chan, J., Coolican, H., Coulshed, S., Edwards, M. E., Erickson, B. J., Fernando, M., Foster, S., Gregory, A. V., Haloob, I., Hawley, C. M., ... Harris, D. C. H. (2022). Prescribed water intake in autosomal dominant polycystic kidney disease. NEJM evidence, 1(1), 1-13. Article EVIDoa2100021. https://doi.org/10.1056/EVIDoa2100021

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title = "Prescribed water intake in autosomal dominant polycystic kidney disease",

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).",

author = "Rangan, {Gopala K.} and Wong, {Annette T. Y.} and Alexandra Munt and Zhang, {Jennifer Q. J.} and Sayanthooran Saravanabavan and Sandra Louw and Margaret Allman-Farinelli and Badve, {Sunil V.} and Neil Boudville and Jessie Chan and Helen Coolican and Susan Coulshed and Edwards, {Marie E.} and Erickson, {Bradley J.} and Mangalee Fernando and Sheryl Foster and Gregory, {Adriana V.} and Imad Haloob and Hawley, {Carmel M.} and Jane Holt and Kirsten Howard and Martin Howell and Johnson, {David W.} and Kline, {Timothy L.} and Karthik Kumar and Lee, {Vincent W.} and Maureen Lonergan and Jun Mai and Philip McCloud and Elaine Pascoe and Anthony Peduto and Anna Rangan and Roger, {Simon D.} and Julie Sherfan and Kamal Sud and Torres, {Vicente E.} and Eswari Vilayur and Harris, {David C. H.}",

year = "2022",

month = jan,

day = "9",

doi = "10.1056/EVIDoa2100021",

language = "English",

volume = "1",

pages = "1--13",

journal = "NEJM evidence",

issn = "2766-5526",

publisher = "Massachussetts Medical Society",

number = "1",

}

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 2022, 'Prescribed water intake in autosomal dominant polycystic kidney disease', NEJM evidence, vol. 1, no. 1, EVIDoa2100021, pp. 1-13. https://doi.org/10.1056/EVIDoa2100021

TY - JOUR

T1 - Prescribed water intake in autosomal dominant polycystic kidney disease

AU - Rangan, Gopala K.

AU - Wong, Annette T. Y.

AU - Munt, Alexandra

AU - Zhang, Jennifer Q. J.

AU - Saravanabavan, Sayanthooran

AU - Louw, Sandra

AU - Allman-Farinelli, Margaret

AU - Badve, Sunil V.

AU - Boudville, Neil

AU - Chan, Jessie

AU - Coolican, Helen

AU - Coulshed, Susan

AU - Edwards, Marie E.

AU - Erickson, Bradley J.

AU - Fernando, Mangalee

AU - Foster, Sheryl

AU - Gregory, Adriana V.

AU - Haloob, Imad

AU - Hawley, Carmel M.

AU - Holt, Jane

AU - Howard, Kirsten

AU - Howell, Martin

AU - Johnson, David W.

AU - Kline, Timothy L.

AU - Kumar, Karthik

AU - Lee, Vincent W.

AU - Lonergan, Maureen

AU - Mai, Jun

AU - McCloud, Philip

AU - Pascoe, Elaine

AU - Peduto, Anthony

AU - Rangan, Anna

AU - Roger, Simon D.

AU - Sherfan, Julie

AU - Sud, Kamal

AU - Torres, Vicente E.

AU - Vilayur, Eswari

AU - Harris, David C. H.

PY - 2022/1/9

Y1 - 2022/1/9

N2 - 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).

AB - 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).

U2 - 10.1056/EVIDoa2100021

DO - 10.1056/EVIDoa2100021

M3 - Article

C2 - 38319283

SN - 2766-5526

VL - 1

SP - 1

EP - 13

JO - NEJM evidence

JF - NEJM evidence

IS - 1

M1 - EVIDoa2100021

ER -

Prescribed water intake in autosomal dominant polycystic kidney disease

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