Blog entry by Meguid El Nahas

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by Meguid El Nahas - Sunday, 16 November 2014, 3:48 PM
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FROM PROFESSOR GLASSOCK AT ASN 2014:

HALT-PKD- study a showed the a lower BP goal slows rate of increase of total kidney volume (TKV), reduces LVH, reduces albuminuria but has no effect on decline in eGFR (no mGFR reported.  Dual ACEi + ARB neither beneficial or harmful.  High uncertainty whether the short-term benefits on TKV change and LVH will have a benefit on Survival or ESRD.

Comments:

Disconnect between BP lower targets and reduction in LVH/albuminuria AND PKD progression in terms of decline of eGFR.

This raises questions regarding the assumption (made for instance in mTOR inhibitors in  ADPKD) that a reduction in TKV (Total Kidney Volume) would translate into slowewr ADPKD progression.

Also raises questions regarding the assumption that a reduction in LVH would imrpove CKD survival (by analogy here...a higher hematocrit improves LVH but doesnt survival...).

Clinical trials in Nephrology are a huge challenge:

1. Surrogate markers are unpredictable at best in terms of outcomes.

2. Hard endpoints would take 5-10 years to reach.

UNLESS, BETTER RISK STRATIFICATION OF THOSE INCLUDED IN RCTs. CHOOSING ESTABLISHED AND PREDICTABLE PROGRESSORS (if possible) WHERE A RESPONSE TO AN INTERVENTION WOULD BE MORE LIKELY.

 

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