Renal MRI Assessment of the Effects of High-Water Intake on Total Kidney Volume Growth in ADPKD

Motivation: By measuring height-adjusted total kidney volume (ht-TKV), renal MRI monitors autosomal dominant polycystic kidney disease (ADPKD) progression and evaluates therapeutic interventions’ efficacy for slowing cyst growth. Goal(s): Since arginine vasopressin (AVP) stimulates cyst growth, reducing vasopressin with high-water intake (HWI) may slow ADPKD progression. Approach: We test this hypothesis using a case-crossover study with 7 ADPKD subjects, measuring ht-TKV changes on MRI during usual and high-water intake. Results: High-water intake decreased 24-hour urine osmolality (359 vs 202mOsm/kg, p=0.002) and rate of increase in annualized ht-TKV growth rate (7.1% vs 3.5%, p=0.003), suggesting that high-water intake can slow ADPKD progression. Impact: Decreasing the rate of ht-TKV increase, measured by renal MRI during high water intake, suggests this as a potential treatment to slow progression of ADPKD, forestalling end-stage kidney failure requiring dialysis or transplantation.