Weekly issue 2026-W42 ·
Chronic Pain in Autosomal Dominant Polycystic Kidney Disease and the Long-Term Effects of Increasing Water Intake
Plain language
Back and abdominal pain are common in autosomal dominant polycystic kidney disease (ADPKD). This post-hoc analysis of the 3-year PREVENT-ADPKD randomized trial looked at pain questionnaires collected every six months from 184 adults assigned either to drink more water (92 people) or to keep their usual water intake (92 people). At the start of the study, two thirds reported back pain and about one third reported abdominal pain. Increasing water intake was linked to a temporary drop in back pain at 12–18 months that was not sustained at 3 years, and it did not change how abdominal pain evolved, although fewer people in the high-water group used painkillers (16% vs 31%). Because pain was not the primary outcome of the trial, the authors describe these findings as exploratory.
Clinical note
Post-hoc exploratory analysis of the 3-year PREVENT-ADPKD randomized trial (Kidney360; n = 184: 92 allocated to increased water intake targeting urine osmolality ≤ 270 mOsm/kg vs 92 usual intake), assessing HALT-PKD pain questionnaires biannually. At baseline, 66% reported back pain and 33–38% abdominal pain; both were associated with higher baseline eGFR (75–90 mL/min/1.73 m²). In the increased-water arm, back pain fell transiently by 33% at 12–18 months (p = 0.04) but was not sustained at 3 years (p = 0.21), with no effect on abdominal pain progression. Lower eGFR (30–45 mL/min/1.73 m²) predicted abdominal pain progression over 3 years on multivariable analysis (p = 0.03). Analgesic use was lower in the increased-water group (16% vs 31%, p < 0.001). Exploratory secondary analysis.
Question for your next visit
What is a safe amount of water for me to drink each day, and what options do I have for managing kidney-related pain?