2) This program is supported by an educational grant from Otsuka Pharmaceutical & is intended for healthcare providers. #HCPs 🇺🇸🇨🇦🇪🇺🇬🇧 earn 0.5hr CE/#CME credit. Statement of accreditation & faculty disclosures at https://t.co/R8QNlBI85W.
— @CKD_ce (@ckd_ce) January 31, 2023
4) The cysts progressively ⬇️the number of functional nephrons ➡️ chronic kidney disease (#CKD). In western countries ADPKD accounts for as much as 8 to 10% of the causes of end-stage kidney disease #ESKD #ESRD.
— @CKD_ce (@ckd_ce) January 31, 2023
🔓https://t.co/WgLA3TlJfW
🔓 https://t.co/Qg1bfzGsKj pic.twitter.com/bnS66HYgVn
6) In approximately 80% of cases the genetic variations responsible for ADPKD are located in PKD1, encoding polycystin 1. Other genes less frequently involved in ADPKD are PKD2 (encoding polycystin 2), GANAB, DNAJB11 and, recently identified, IFT140.https://t.co/Mm9xOKUhuU pic.twitter.com/eT1LAOnRJU
— @CKD_ce (@ckd_ce) January 31, 2023
8) Importantly, #polycystins are found in most cells of the vasculature and heart. Increasing evidence suggests that the presence of abnormal polycystins at the vascular level is one of the main factors in #CV manifestations in ADPKD.https://t.co/GnW9zs9Iat pic.twitter.com/Xy7M16SZrt
— @CKD_ce (@ckd_ce) January 31, 2023
10) Now a knowledge ✔️& an important question. Which of these diseases is the leading cause of premature death in patients with #ADPKD ? Mark your answer before scrolling ⬇️!
— @CKD_ce (@ckd_ce) January 31, 2023
12) In patients with ADPKD #hypertension is associated with progression to #ESKD and, as is the case in the general population, with #cardiovascular morbidity and mortality.
— @CKD_ce (@ckd_ce) January 31, 2023
🔓https://t.co/zPiX16NLvV pic.twitter.com/68lSoM5UJd
14) As illustrated by this study and others, the prevalence of hypertension in children with ADPKD and normal kidney function is around 30% (D). This highlights the importance of BP monitoring in children of families with ADPKD.
— @CKD_ce (@ckd_ce) January 31, 2023
🔓 https://t.co/so782Qke8i pic.twitter.com/cercten2P9
16) In #ADPKD, #hypertension typically occurs prior to loss of kidney function. This is no surprise, since other factors than decreased #GFR participate to increase BP in ADPKD.
— @CKD_ce (@ckd_ce) January 31, 2023
Which one of these would you consider as a major explanation to the early hypertension in ADPKD ?
18) Welcome back! You are learning about the extrarenal manifestations of #ADPKD, the most frequent hereditary cause of #kidneydisease. Our expert faculty is @dguerrot and you are earning FREE CE/#CME!
— @CKD_ce (@ckd_ce) February 1, 2023
Hello to @MuellerRom @NatRevNeph @goKDIGO @MattLanktree @iamnephrologist
20) Immunohistologic and clinical studies support a role of #RAAS in the pathogenesis of #hypertension in #ADPKD.
— @CKD_ce (@ckd_ce) February 1, 2023
🔓 https://t.co/2aZwUUkzf2
🔓https://t.co/ZkPMXEayDN pic.twitter.com/yFSFmB3YDA
21b) Endothelium-specific deficiency of polycystin-1 promotes #hypertension and #cardiovascular disorders @dguerrot @dorian_nezam @nephrohamzaoui @vrichard_rouen https://t.co/aGo1lDKRXY pic.twitter.com/Qp8XPKhRAQ
— @CKD_ce (@ckd_ce) February 1, 2023
23) In most patients with #ADPKD, #hypertension is grade 1 or 2, and typically requires only 1 or 2 antihypertensive agents in addition to lifestyle measures for adequate blood pressure control. pic.twitter.com/gM553CuGNL
— @CKD_ce (@ckd_ce) February 1, 2023
25) Share educational material with your patients ! 🔓https://t.co/h9O431Tnfe
— @CKD_ce (@ckd_ce) February 1, 2023
27) The HALT-A RCT compared standard BP targets (120/70 to 130/80 mm Hg) to low BP targets (95/60 to 110/75 mm Hg) in ADPKD pts with eGFR > 60. Primary outcome was annual percentage change in the total kidney volume, a surrogate for CKD progression.
— @CKD_ce (@ckd_ce) February 1, 2023
🔓https://t.co/EW1Yl7NKjm pic.twitter.com/8Hv57jmc9F
29) In the HALT-A trial (young hypertensive pts), aggressive BP control was safe. This level of BP control, compared with standard BP targets, was assoc'd with a modest⬇️in total kidney volume over time, without differences in the slope of the #eGFR.
— @CKD_ce (@ckd_ce) February 1, 2023
🔓https://t.co/SgcFeuToYW pic.twitter.com/k7QG5wu4wK
31) Therefore, HALT-A suggests that in young ADPKD patients with CKD stage 1 to 2 and no other significant comorbidity, if tolerated, strict BP control (SBP 95-110 / DBP 60-75 mm Hg) is safe and may be advantageous. pic.twitter.com/gAEL7KfjPH
— @CKD_ce (@ckd_ce) February 1, 2023
33) Compared to #RAASi, in small studies & subgroup analyses, Ca channel blockers have been associated with a less favorable impact on #eGFR slope & albuminuria & are therefore not first step antihypertensive drugs in #ADPKD
— @CKD_ce (@ckd_ce) February 1, 2023
🔓https://t.co/xjAgX2bzn1https://t.co/uCpvF6pUOv
35) Optimized management of hypertension in adults ADPKD is summarized in the following Table. Note that an update on the @goKDIGO guideline for ADPKD is expected soon, and will include the studies published since then.
— @CKD_ce (@ckd_ce) February 1, 2023
🔓 https://t.co/KwfHOGWWNM
🔓 https://t.co/3baZZswmkd pic.twitter.com/M2ZGgtjqSH
37) Cerebral aneurysm rupture in ADPKD is a scary outcome: “when it happens it’s devastating”, as was identified by the @song_initiative PKD initiative, which defines core outcomes for future trials which are of relevance to both patients & clinicians.https://t.co/0pp1hCaZqB
— @CKD_ce (@ckd_ce) February 1, 2023
39) The prevalence of cerebral aneurysms increases when there is a family history of cerebral aneurysm or intracranial hemorrhage #ICH (20-28 %). This reflects shared hereditary predispositions in modifier genes. pic.twitter.com/eGqj0fSC5i
— @CKD_ce (@ckd_ce) February 1, 2023
41) The large Genkyst obs cohort revealed prevalence of aneurysms in pts w/PKD1 > PKD2 variations. This could be due to a direct role on arterial remodeling or more probably to indirect implications, in particular via severity of hypertension & CKD.https://t.co/XYN3WPNDoI
— @CKD_ce (@ckd_ce) February 1, 2023
43) Systematic screening for intracranial aneurysms in ADPKD is debated. Guidelines do not currently recommend it for all patients with ADPKD, but in certain groups at elevated risk.
— @CKD_ce (@ckd_ce) February 1, 2023
🔓https://t.co/YJdxQSysq7
🔓https://t.co/St6Ppq4z9i pic.twitter.com/nnHsieFgyP
45) Mark your best answer and return tomorrow for a wrap-up of this program and a link to your FREE CE/#CME! Don't miss it!
— @CKD_ce (@ckd_ce) February 1, 2023
Tip o' the hat to @ChristosArgyrop @IgAN_JBarratt @JHernandez_RX @Kidney_Int @ASNKidney @Vishal_D_Patel @NephPrasad @NephroWorldCup @HDiniz_
47) Time-of-flight MRI without gadolinium enhancement is the screening method of choice to identify cerebral aneurysms in ADPKD. 3D-TOF MRI can detect aneurysms above 2 mm. See:https://t.co/X8VXPCWziM
— @CKD_ce (@ckd_ce) February 2, 2023
🔓https://t.co/rjnVcplLxN
🔓https://t.co/St6Ppq4z9i pic.twitter.com/u2hyuiJp8K
49) Less known, in #ADPKD the prevalence of aneurysms is also increased in extracranial arteries, including in the ascending and descending aorta. See
— @CKD_ce (@ckd_ce) February 2, 2023
🔓 https://t.co/ptN2JsJUA9 https://t.co/DgZFRjqwBM pic.twitter.com/K7Ki1tllBF
51) Another important issue relevant to ADPKD is the 🫀. Indeed, patients with #ADPKD present an ⬆️prevalence of several #cardiac anomalies.
— @CKD_ce (@ckd_ce) February 2, 2023
🔓 https://t.co/NyzdqoNgGH pic.twitter.com/jYd31zX61k
53) An analysis of 667 #ADPKD patients with #echocardiographic data found that 6% had idiopathic dilated cardiomyopathy with a mean ejection fraction #LVEF of 25%.
— @CKD_ce (@ckd_ce) February 2, 2023
🔓 https://t.co/UxSLjwMFZg pic.twitter.com/tRPs6LgtVu
55) Mild valvular disorders, especially #mitralvalveprolapse (20-30%), are more frequent in ADPKD. https://t.co/TFCj8dSzrC pic.twitter.com/CMPrbjHMcH
— @CKD_ce (@ckd_ce) February 2, 2023
57) This Table summarizes the main studies reporting 🫀disorders in patients with #ADPKD
— @CKD_ce (@ckd_ce) February 2, 2023
🔓 https://t.co/NyzdqoNOwf pic.twitter.com/CXq0xuo1XL
59) As we have seen, therapeutic management aimed at reducing #CVD in ADPKD is mainly based on optimized treatment of hypertension including #RAASi
— @CKD_ce (@ckd_ce) February 2, 2023
61) This favorable effect most probably results from the beneficial effect on kidney disease progression
— @CKD_ce (@ckd_ce) February 2, 2023
🔓 https://t.co/d3V0JTjmZR pic.twitter.com/Tw6kxPe5U3
63) Useful links and information for the patients with ADPKD you care for can be found here https://t.co/xogP4axNYk here https://t.co/PJKGsTDEFT here https://t.co/zEj1xSKFsB or here https://t.co/9IFwUXrV44 ! pic.twitter.com/6aL4v6xkiI
— @CKD_ce (@ckd_ce) February 2, 2023