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Indian J Nephrol
Indian J Nephrol
IJN
Indian Journal of Nephrology
0971-4065
1998-3662
Scientific Scholar

10.25259/ijn_561_23
10.25259/ijn_561_23
Letter to the Editor
Autosomal Dominant Polycystic Kidney Disease in Older Adults
Wu Henry H. L. 1
Wood Grahame 2
Chinnadurai Rajkumar 23
1 Renal Research, Kolling Institute of Medical Research, Royal North Shore Hospital and The University of Sydney, Sydney, Australia
2 Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK
3 Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
Corresponding author: Rajkumar Chinnadurai, Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK. E-mail: rajkumar.chinnadurai@nca.nhs.uk
06 5 2024
20 7 2024
Jul-Aug 2024
34 4 407407
21 12 2023
25 12 2023
© 2024 Indian Journal of Nephrology | Published by Scientific Scholar
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
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pmcDear Editor,

While the epidemiology and clinical characteristics of autosomal dominant polycystic kidney disease (ADPKD) in children and younger adults are clearly defined, it is much less so for older adults.1 This may be explained by the fact that older adults living with ADPKD are difficult to screen, as many have milder forms of disease with subtle clinical presentations. ADPKD patients who have more severe forms of the disease may not survive to old age, with complications such as cardiovascular events and septic infections resulting in early mortality. Observational studies detailing the clinical characteristics of the older ADPKD population are lacking, but the two published studies by Milutinovic et al.2 in the USA and Helal et al.3 in Tunisia have both concurred that ADPKD diagnoses in older adults are often made late, when patients are already diagnosed with kidney failure. Indeed, these trends are backed up by ascertainment of the prevalent genetic profile in older ADPKD cohorts, in which disease harboring PKD2 gene mutations were common.4 PKD2 mutation produces a milder form of disease, with the mean age of kidney failure occurring approximately 20 years later than ADPKD with PKD1 mutation.4 Disease modification trials typically excluded patients aged >55, hence the impact of treatment in older adults with ADPKD is still relatively uncertain.5 It will likely require several years for therapies to show any efficacy toward renal endpoints of these patients, which makes investigation challenging. Moreover, potential therapies often have important side effects, and benefits of treatment, if any, will unlikely outweigh risks in this patient population. Going forward, further comprehensive data in diverse populations is anticipated to determine potential solutions for earlier ADPKD identification and establish strategies to reduce progression of disease in older patient cohorts.

Conflicts of interest

There are no conflicts of interest.

How to cite this article: Wu HHL, Wood G, Chinnadurai R. Autosomal Dominant Polycystic Kidney Disease in Older Adults. Indian J Nephrol. 2024;34:407. doi: 10.25259/ijn_561_23
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References

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2. Milutinovic J Fialkow PJ Agodoa LY Phillips LA Rudd TG Sutherland S Clinical manifestations of autosomal dominant polycystic kidney disease in patients older than 50 years Am J Kidney Dis 1990 15 237 43 10.1016/s0272-6386(12)80768-2 2137671
3. Helal I Lassoued F Maiz HB Kheder A Clinical presentation and outcomes of autosomal dominant polycystic kidney disease in the elderly Am J Med Sci Med 2013 1 18 20
4. Torra R Badenas C Pérez-Oller L Luis J Millán S Nicolau C et al Increased prevalence of polycystic kidney disease type 2 among elderly polycystic patients Am J Kidney Dis 2000 36 728 34 10.1053/ajkd.2000.17619 11007674
5. Chebib FT Zhou X Garbinsky D Davenport E Nunna S Oberdhan D et al Tolvaptan and kidney function decline in older individuals with autosomal dominant polycystic kidney disease: A pooled analysis of randomized clinical trials and observational studies Kidney Med 2023 5 100639 10.1016/j.xkme.2023.100639 37250503
