Hypertension Resistant to RAAS Inhibitors as a Prognostic Indicator for Rapid Progression to ESRD in ADPKD: A Ten-Year Follow-Up
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Data Collection
2.3. Outcomes and Follow-Up
2.4. Statistical Analysis
2.5. Software and Ethics
3. Results
3.1. Patient Demographics and Clinical Characteristics
3.2. Treatment and Therapeutic Patterns
3.3. Biochemical Parameters and eGFR Progression
3.4. Identification of Predictive Factors for CKD Progression
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | No. (%) |
---|---|
Male Sex | 59 (44.36) |
Family History | 113 (85.00) |
PKD Gene | |
PKD1 | 98 (73.68) |
PKD2 | 14 (10.53) |
No Mutation Identified | 21 (15.79) |
Extrarenal Manifestations | |
Cerebral Aneurysm | 2 (1.50) |
Pulmonary Disease | 3 (2.26) |
Nephrolithiasis (Kidney Stones) | 11 (8.27) |
IPMN * | 23 (17.29) |
Cardiac Hypertrophy | 50 (37.59) |
Cardiac Valve Defect | 8 (6.02) |
Diabetes Mellitus | 3 (2.26) |
Diverticulosis | 5 (3.76) |
Kidney Pain (>2 episodes/year) | 70 (52.63) |
Hernia | 9 (6.77) |
Risk Factors for End-Stage Kidney Disease | |
Smoking | 14 (10.53) |
Cyst Infection (per year) | 19 (14.29) |
Hypertension | 74 (55.63) |
Urinary Tract Infection | 39 (29.32) |
Hematuria | 38 (28.57) |
Nephrectomy | 2 (1.50) |
Mayo Classification for ADPKD | |
Mayo 1A | 33 (24.81) |
Mayo 1B | 46 (34.59) |
Mayo 1C | 27 (20.30) |
Mayo 1D | 16 (12.03) |
Mayo 1E | 11 (8.27) |
Treatments | |
ACE Inhibitors | 64 (48.12) |
ARBs | 23 (17.29) |
Other Antihypertensive Drugs | 10 (7.5) |
No Antihypertensive | 36 (27.1) |
RAAS + Other Antihypertensives | 37 (27.8) |
Tolvaptan | 17 (12.80) |
Proteinuria > 300 mg/24 h, Baseline | 33 (24.81) |
Proteinuria > 300 mg/24 h, Last Visit | 49 (36.84) |
Variable | Median (IQR) |
---|---|
Age (years) | 52.1 (13.2) |
Height (cm) | 165.89 (7.95) |
Weight (kg) | 65.2 (10.9) |
Body Mass Index (kg/m2) | 23.74 (7.41) |
Body Surface Area (m2) | 1.7268 (0.1497) |
Kidney Volume on MRI (mL) | 1379.95 (881.8) |
Annual eGFR slope (mL/min/1.73 m2) | 3.8 (2.38) |
eGFR (first visit) (mL/min/1.73 m2) | 67.9 (31.0) |
eGFR (last visit) (mL/min/1.73 m2) | 48.9 (32.9) |
eGFR slope (mL/min/1.73 m2) in 5 years | 19.0 (11.89) |
PRO-PKD score, median (IQR) | 4 (2–6) |
Covariate | OR | Lower CI (95%) | Upper CI (95%) | p-Value |
---|---|---|---|---|
ACEI | 1.475 | 0.604 | 3.603 | 0.39346 |
Age | 1.029 | 0.994 | 1.065 | 0.10244 |
Antihypertensive Drugs, Other† | 3.03 | 1.16 | 7.914 | 0.02360 |
ARBS | 1.247 | 0.415 | 3.749 | 0.69460 |
Body Mass Index | 1.026 | 0.933 | 1.129 | 0.59939 |
Body Surface Area | 1.099 | 0.059 | 20.584 | 0.94980 |
Cyst Infection | 1.458 | 0.379 | 5.614 | 0.58329 |
Diabetes | 2.923 | 0.291 | 29.356 | 0.36211 |
Diverticulosis | 6.333 | 0.726 | 55.221 | 0.09480 |
Estimated Heart Risk | 1.029 | 0.994 | 1.065 | 0.10365 |
eGFR, first visit | 0.969 | 0.952 | 0.987 | 0.00059 |
Hernia | 4.0 | 0.427 | 37.459 | 0.22451 |
Hypertension | 1.96 | 0.767 | 5.01 | 0.15963 |
htTKV | 1.0 | 0.999 | 1.001 | 0.66333 |
Hypertension on drugs | 1.552 | 0.622 | 3.87 | 0.34593 |
Kidney Pain | 2.336 | 0.958 | 5.697 | 0.06218 |
Kidney Volume to Body Surface Area | 1.0 | 0.999 | 1.001 | 0.65432 |
MRI kidney volume | 1.0 | 0.999 | 1.0 | 0.67345 |
Proteinuria, Time 0 | 0.682 | 0.187 | 2.48 | 0.56100 |
Macrohematuria, recurrent | 0.655 | 0.227 | 1.889 | 0.43313 |
Smoking | 0.893 | 0.357 | 2.232 | 0.80847 |
Tolvaptan | 1.1 | 0.335 | 3.614 | 0.87522 |
Urinary Tract Infection | 1.603 | 0.574 | 4.482 | 0.36799 |
Weight | 1.005 | 0.966 | 1.046 | 0.79594 |
Variable | OR | 95% CI (Upper) | 95% CI (Lower) | p-Value |
---|---|---|---|---|
eGFR, first visit | 0.993 | 0.989 | 0.997 | 0.0012 |
Antihypertensive Drugs, Other † | 1.272 | 1.032 | 1.569 | 0.0248 |
Diverticulosis | 1.204 | 829 | 1.75 | 0.3255 |
Kidney Pain | 1.118 | 911 | 1.372 | 0.2810 |
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Angioi, A.; Piras, D.; Lepori, N.; Floris, M.; Cabiddu, G.; Pani, A. Hypertension Resistant to RAAS Inhibitors as a Prognostic Indicator for Rapid Progression to ESRD in ADPKD: A Ten-Year Follow-Up. Diagnostics 2025, 15, 2583. https://doi.org/10.3390/diagnostics15202583
Angioi A, Piras D, Lepori N, Floris M, Cabiddu G, Pani A. Hypertension Resistant to RAAS Inhibitors as a Prognostic Indicator for Rapid Progression to ESRD in ADPKD: A Ten-Year Follow-Up. Diagnostics. 2025; 15(20):2583. https://doi.org/10.3390/diagnostics15202583
Chicago/Turabian StyleAngioi, Andrea, Doloretta Piras, Nicola Lepori, Matteo Floris, Gianfranca Cabiddu, and Antonello Pani. 2025. "Hypertension Resistant to RAAS Inhibitors as a Prognostic Indicator for Rapid Progression to ESRD in ADPKD: A Ten-Year Follow-Up" Diagnostics 15, no. 20: 2583. https://doi.org/10.3390/diagnostics15202583
APA StyleAngioi, A., Piras, D., Lepori, N., Floris, M., Cabiddu, G., & Pani, A. (2025). Hypertension Resistant to RAAS Inhibitors as a Prognostic Indicator for Rapid Progression to ESRD in ADPKD: A Ten-Year Follow-Up. Diagnostics, 15(20), 2583. https://doi.org/10.3390/diagnostics15202583