• Dana C Miskulin, Kaleab Z Abebe, Arlene B Chapman, Ronald D Perrone, Theodore I Steinman, Vicente E Torres, K Ty Bae, William Braun, Franz T Winklhofer, Marie C Hogan, Fred Rahbari-Oskoui, Charity G Moore, Michael F Flessner, Robert W Schrier, and HALT-PKD Study.
• Tufts Medical Center, Boston, MA. Electronic address: dmiskulin@tuftsmedicalcenter.org.
• Am. J. Kidney Dis. 2014 Feb 1;63(2):214-26.

BackgroundIn people with early autosomal dominant polycystic kidney disease (ADPKD), average total kidney volume (TKV) is 3 times normal and increases by an average of 5% per year despite a seemingly normal glomerular filtration rate (GFR). We hypothesized that increased TKV would be a source of morbidity and diminished quality of life that would be worse in patients with more advanced disease.Study DesignCross-sectional.Setting & Participants1,043 patients with ADPKD, hypertension, and a baseline estimated GFR (eGFR)> 20mL/min/1.73m(2).Predictors(1) eGFR, (2) height-adjusted TKV (htTKV) in patients with eGFR> 60mL/min/1.73m(2).Outcomes36-Item Short Form Health Survey (SF-36) and the Wisconsin Brief Pain Survey.MeasurementsQuestionnaires were self-administered. GFR was estimated from serum creatinine using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation. htTKV was measured by magnetic resonance imaging.ResultsBack pain was reported by 50% of patients, and 20% experienced it "often, usually, or always." In patients with early disease (eGFR> 60mL/min/1.73m(2)), there was no association between pain and htTKV, except in patients with large kidneys (htTKV> 1,000mL/m). Comparing across eGFR levels and including patients with eGFRs< 60mL/min/1.73m(2), patients with eGFRs of 20-44mL/min/1.73m(2) were significantly more likely to report that pain impacted on their daily lives and had lower SF-36 scores than patients with eGFRs of 45-60 and ≥60mL/min/1.73m(2). Symptoms relating to abdominal fullness were reported by 20% of patients and were related significantly to lower eGFRs in women, but not men.LimitationsTKV and liver volume were not measured in patients with eGFR < 60mL/min/1.73m(2). The number of patients with eGFRs< 30mL/min/1.73m(2) is small. Causal inferences are limited by cross-sectional design.ConclusionsPain is a common early symptom in the course of ADPKD, although it is not related to kidney size in early disease (eGFR> 60mL/min/1.73m(2)), except in individuals with large kidneys (htTKV> 1,000 mL/m). Symptoms relating to abdominal fullness and pain are greater in patients with more advanced (eGFR, 20-45mL/min/1.73m(2)) disease and may be due to organ enlargement, especially in women. More research about the role of TKV in quality of life and outcomes of patients with ADPKD is warranted.Copyright © 2014 National Kidney Foundation, Inc. All rights reserved.

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