Weekly issue 2026-W43 ·
Renal Blood Flow as Marker for Disease Progression in ADPKD
Plain language
Doctors currently estimate how quickly autosomal dominant polycystic kidney disease (ADPKD) is likely to progress mainly from kidney size (total kidney volume) and blood tests for kidney function (eGFR). This prospective study followed 238 adults with ADPKD for an average of 5.6 years and compared them with 1,421 healthy controls. Even in young adults whose eGFR was still similar to healthy controls, blood flow through the kidneys (renal blood flow) was already lower in ADPKD. Over follow-up, patients with higher renal blood flow lost kidney function more slowly and had a lower risk of rapid progression or kidney failure. Adding renal blood flow to the Mayo imaging classification improved prediction of rapid progression in this observational cohort.
Clinical note
Prospective observational cohort study (Kidney Int Rep; DIPAK observational cohort) of n = 238 adults with ADPKD and n = 1,421 healthy controls, followed for 5.6 ± 3.5 years. Cross-sectionally, renal blood flow (RBF) was significantly lower in ADPKD than in controls across all age groups, including young patients with preserved eGFR, and correlated with lower eGFR and larger TKV. Filtration fraction (FF) was elevated at ages 30–40 years but did not predict progression. Longitudinally, each 1-SD higher RBF was associated with slower annual eGFR decline (standardized β = 0.34, 95% CI 0.09–0.58, p = 0.01), lower odds of rapid progression ≥ 3.0 mL/min/1.73 m²/year (OR 0.34, 95% CI 0.17–0.70, p = 0.003), and lower composite risk of kidney failure or ≥ 30% eGFR decline (HR 0.35, 95% CI 0.20–0.60, p < 0.001). Adding RBF to the Mayo Imaging Classification increased the AUC for rapid progression from 0.69 (95% CI 0.60–0.76) to 0.79 (95% CI 0.72–0.85).
Question for your next visit
Which tests and imaging markers do we currently use to estimate my risk of kidney disease progression?