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| |  Antihypertensive Therapy May Delay Kidney Failure In Polycystic Kidney Disease KANSAS CITY, MO -- March 30, 2000 -- A study published in the March issue of American Journal of Kidney Diseases may hold promise for an effective treatment for delaying the progression of a form of polycystic kidney disease (PKD). Research from the University of Colorado School of Medicine shows treating patients with autosomal dominant polycystic kidney disease (ADPKD), with medication to control high blood pressure, could delay the onset of kidney failure by approximately 15 years. Polycystic kidney disease is the most common of all life-threatening genetic diseases and affects 12 to 15 million children and adults worldwide. The disease appears in two hereditary forms: autosomal dominant (ADPKD), the most common life-threatening genetic disease, and autosomal recessive (ARPKD), a less-frequently inherited disease that often causes significant mortality in the first month of life. Seventy percent of ADPKD individuals with normal kidney function have high blood pressure. This occurs on average 10 years earlier than essential hypertension in the general population. Cardiovascular disease is the major cause of death in ADPKD and may be related to the high and early frequency of high blood pressure. This study compares the effects of the calcium channel blocker (CCB) amlodipine and the ACE inhibitor enalapril as first-line therapy on blood pressure, kidney function, and urinary albumin excretion. Twenty-four patients with ADPKD and hypertension with creatinine clearances greater than 50 ml/min were included in the study, with 12 patients receiving a mean dose of 9mg/d of amlodipine and 12 patients receiving a mean dose of 17mg/d of enalapril. Patients were followed for five years. Both amlodipine and enalapril had a similar affect on blood pressure, but enalapril treatment decreased urinary albumin excretion during the entire five-year follow-up period. The rate of loss of kidney function was slow in both groups of patients treated in this study. Longer follow-up studies will be necessary to examine whether the decreased urinary albumin excretion is an indicator of better long-term renal and cardiac protection in ADPKD with the angiotensin converting enzyme inhibitors class of high blood pressure medication, like enalapril. The study shows that blood pressure control is a predictor of relative preservation of kidney function as in ADPKD. "Early treatment of hypertension may help to delay the age of onset into end-stage renal disease by more than a decade," said Arlene B. Chapman, M.D., associate professor of medicine, Emory University, and chairman of the Polycystic Kidney Research Foundation Scientific Advisory Committee. Robert Schrier, M.D., principal investigator of the study and professor and chair of medicine at the University of Colorado, stated that early and aggressive control of blood pressure is the primary treatment available to decrease progression of renal disease and cardiovascular complications in ADPKD patients. The Polycystic Kidney Research Foundation is the world's only organization dedicated to discovering the cause, improving clinical treatment and finding a cure for PKD. In addition to promoting programs of biomedical research, the organization strives to build public awareness and to educate patients, the U.S. Congress and physicians about the disease. In addition, the PKR Foundation operates 46 volunteer support/advocacy groups located throughout the United States and in Canada and Japan.
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