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Cardiovascular abnormalities in autosomal-dominant polycystic kidney disease

Nature Reviews Nephrology volume 5, pages 221–228 (2009)Cite this article

Abstract

Cardiovascular problems are a major cause of morbidity and mortality in patients with autosomal-dominant polycystic kidney disease (ADPKD). Hypertension is a common early symptom of ADPKD, and occurs in approximately 60% of patients before renal function has become impaired. Hypertension is associated with an increased rate of progression to end-stage renal disease and is the most important potentially treatable variable in ADPKD. Left ventricular hypertrophy, which is a powerful, independent risk factor for cardiovascular morbidity and mortality, also occurs frequently in patients with ADPKD. Both hypertension and left ventricular hypertrophy have important roles in cardiovascular complications in these individuals. Moreover, biventricular diastolic dysfunction, endothelial dysfunction, increased carotid intima–media thickness, and impaired coronary flow velocity reserve are present even in young patients with ADPKD who have normal blood pressure and well-preserved renal function. These findings suggest that cardiovascular involvement starts very early in the course of ADPKD. Intracranial and extracranial aneurysms and cardiac valvular defects are other potential cardiovascular problems in patients with ADPKD. Early diagnosis and treatment of hypertension, with drugs that block the renin–angiotensin–aldosterone system, has the potential to decrease the cardiovascular complications and slow the progression of renal disease in ADPKD.

Key Points

  • Cardiovascular problems are a major cause of morbidity and mortality in patients with autosomal-dominant polycystic kidney disease (ADPKD)

  • Hypertension, a common symptom of ADPKD, is associated with rapid progression to end-stage renal disease; the renin–angiotensin–aldosterone system (RAAS) is important in the development of hypertension in this setting

  • Early vascular changes have been reported even in young patients with ADPKD and normal blood pressure

  • Left ventricular hypertrophy is a common finding in patients with ADPKD

  • Patients with ADPKD have a higher prevalence of aneurysms and cardiac valvular abnormalities than the general population

  • Early and effective treatment of hypertension is very important to decrease the morbidity and mortality of patients with ADPKD, and drugs that inhibit the RAAS might be beneficial in this context

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Figure 1: Potential pathogenetic mechanisms of hypertension in autosomal-dominant polycystic kidney disease.97
Figure 2: An approach to assessment of cardiovascular risk factors and management in patients with autosomal-dominant polycystic kidney disease.

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  1. Division of Nephrology, Department of Internal Medicine at Istanbul School of Medicine, Istanbul University, Istanbul, Turkey

    Tevfik Ecder

  2. Division of Renal Diseases and Hypertension at the University of Colorado School of Medicine, Denver, CO, USA

    Robert W. Schrier

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Correspondence to Tevfik Ecder.

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R. W. Schrier has acted as a consultant for Amgen and Otsuka and has received grant research/support from Astellas. T. Ecder declared no competing interests.

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Ecder, T., Schrier, R. Cardiovascular abnormalities in autosomal-dominant polycystic kidney disease. Nat Rev Nephrol 5, 221–228 (2009). https://doi.org/10.1038/nrneph.2009.13

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