Anemia is associated with kidney disease progression in patients with autosomal dominant polycystic kidney disease (ADPKD), new study findings suggest.

Fifty of 115 patients (48 men and 67 women; 45.9 years) experienced a 50% or greater reduction in estimated glomerular filtration rate (eGFR) or need for renal replacement therapy (RRT) over a median 5.5 years of follow-up, Hiroshi Kataoka, MD, PhD, of Tokyo Women’s Medical University and colleagues reported in Clinical and Experimental Nephrology. Hemoglobin (Hb) levels and uric protein content significantly predicted poor renal prognosis, whereas hypertension and genetic mutations did not. Men with Hb concentrations below 12 g/dL and women with Hb concentrations below 11 g/dL were more likely to have kidney disease progression.

“Hb typically remains higher in ADPKD than in CKD of other etiologies because erythropoietin (EPO) is produced in the cysts and parenchymal cells in ADPKD,” Hiroshi Kataoka, MD, PhD, of Tokyo Women’s Medical University and colleagues wrote. “However, our study showed that low Hb was associated with poor renal prognosis in ADPKD patients.”

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This findings may be due to the involvement of hypoxia-inducible factors (HIF), the team explained. “Hypoxia in ADPKD with renal function decline does not lead to EPO production in myofibroblasts despite producing more HIF-2α, effectively lowering Hb. Furthermore, progression of ischemia of the cyst-lining epithelial cells causes interstitial disease, as well as HIF-1α increase and cyst growth, eventually leading to progression of renal dysfunction. This is one reason why anemia may predict poor renal prognosis.”

HIF prolyl hydroxylase inhibitors may promote cystic growth in ADPKD by inhibiting breakdown of both HIF-2α and HIF-1α. They should be administered with caution in this population, according to the investigators.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Ushio Y, Kataoka H, Sato M, et al. Association between anemia and renal prognosis in autosomal dominant polycystic kidney disease: a retrospective study [published online February 8, 2020]. Clin Exp Nephrol. doi: 10.1007/s10157-020-01856-1