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Australia
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Autosomal Dominant Polycystic kidney disease (ADPKD) is a common genetic disease that affects 10,000 Australians. Young people with this condition get many tiny cysts (sacs of fluid) in their kidneys. The kidney cysts slowly grow over time and cause pain, high blood pressure and kidney failure. In Australia, about 2,000 people with ADPKD have kidney failure and need dialysis or a kidney transplant to live.
Doctors have believed for many years that drinking extra water might slow the growth of kidney cysts and may be a simple treatment for ADPKD. This is because a brain hormone called vasopressin makes kidney cysts grow. Drinking more water reduces vasopressin and may slow the growth of kidney cysts.
A team of Australian doctors and scientists lead by Associate Professor Gopi Rangan, Dr. Annette Wong and Professor David Harris at the Westmead Institute for Medical Research (WIMR) and Westmead Hospital, have tested this idea for the first time in a 3-year clinical trial. The findings, which are a result of the PREVENT-ADPKD Clinical Trial, were published in the New England Journal Medicine Evidence and presented at the Meeting of the American Society of Nephrology on 5th November 2021.
In the study, one group of people were advised to drink a personalised volume of extra water per day to keep a low urine concentration and compared to another group who did not change their usual intake. Then the growth of kidney cysts was measured regularly over the 3 years by a magnetic resonance imaging scan. The results showed that drinking extra water beyond their usual intake was safe in all people but did not make a difference to the growth of kidney cysts. Most people in the study were already drinking about 2-2.5 litres of fluid daily. In addition, people in the intervention group found it challenging to drink the extra amount of water prescribed for consumption on a daily basis over the 3 years. These factors may explain the lack of difference between the two groups. The results of this study will make a big difference to the day-to-day lives of people with ADPKD who have been confused and anxious about how much fluid to drink.
In summary:
- PKD is a common genetic disease and causes kidney failure due to the growth of multiple cysts.
- Drinking extra water may assist in managing PKD by slowing the growth of kidney cysts by reducing vasopressin.
- This study showed that drinking around 2-2.5 litres of water per day was safe but more than this had no added benefits for most with PKD and was challenging for people to sustain every day.
There are no effective treatments to prevent kidney failure in people with ADPKD. New treatments in Australia and overseas are currently being developed. More investment in clinical research and clinical trials of ADPKD is needed.
