Dietary Aspects and Drug-Related Side Effects in Autosomal Dominant Polycystic Kidney Disease Progression

Area of Science:

• Nephrology
• Genetics
• Dietary Science

Background:

• Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder, invariably progressing to end-stage renal disease without targeted therapies.
• Tolvaptan, a vasopressin V2 receptor antagonist, is the sole approved treatment, reducing cyst growth and slowing kidney function decline.
• Tolvaptan's primary side effect, aquaresis, leads to high discontinuation rates, necessitating management strategies.

Purpose of the Study:

• To critically review existing evidence on dietary modifications for ADPKD management.
• To explore strategies for mitigating the aquaretic side effects of tolvaptan therapy.
• To provide evidence-based dietary recommendations for ADPKD patients.

Main Methods:

• Systematic review of scientific literature on dietary interventions in ADPKD.
• Analysis of studies investigating the impact of diet on cystogenesis and kidney function.
• Evaluation of strategies to counteract tolvaptan-induced aquaresis.

Main Results:

• Dietary interventions like moderate sodium restriction, controlled protein intake, weight management, and adequate hydration show potential in slowing ADPKD progression, albeit with low-grade evidence.
• Strategies to manage tolvaptan-induced aquaresis include thiazide diuretics, metformin, and reducing dietary osmotic load.
• Evidence suggests dietary modifications can complement tolvaptan therapy and improve patient adherence.

Conclusions:

• Dietary interventions represent a crucial, yet underutilized, component in managing ADPKD.
• Effective management of tolvaptan's aquaresis through dietary strategies can improve treatment adherence and outcomes.
• Further high-quality research is needed to solidify evidence-based dietary guidelines for ADPKD.