Recommendation
We recommend that patients with ADPKD who are younger than 50 years with eGFR > 60 mL/min/1.73m2 and without significant cardiovascular comorbidities should have a target BP of ≤ 110/75 mm Hg, realizing that in some patients an individual target may be needed.
Nontargeted Treatment Options
Nontargeted treatment options for ADPKD include protein restriction, increased fluid intake, and blood pressure (BP) control. To date, no study has been able to demonstrate the benefit of protein restriction in patients with ADPKD.51
Increased fluid intake has received a great deal of attention as a therapeutic approach to improving disease progression in ADPKD; however, there are currently no compelling data to support increased water intake as a treatment option to prevent disease progression in ADPKD. A recent study demonstrated no benefit on disease progression in ADPKD among patients in the high water intake group compared with the free water intake group.52
Rigorous BP control (95/60-110/75 mm Hg) was associated with a significantly lower annual rate of increase in TKV compared with a standard BP target (120/70-130/80 mm Hg): 5.6% versus 6.5%; P = .006.53 Patients in the tighter BP control group also experienced a reduction in urinary albumin excretion per year (−3.8%) versus an increase (2.4%) in the standard BP group (P < .001), but there was no significant difference between the 2 groups in annual change in eGFR (−2.9 mL/min/1.73 m2 vs −3.0 mL/min/1.73 m2, respectively; P = .55). Similarly, a post hoc analysis of the early ADPKD population in the Halt Polycystic Kidney Disease (HALT-PKD) Study A demonstrated a stronger benefit of rigorous BP control on TKV increase, as well as a stronger benefit on eGFR decline, in the subgroup of patients with severe disease (classes 1D and E).54