No Added Benefit with Two-Drug Tx in Polycystic Kidney Disease

In patients with autosomal dominant polycystic kidney disease (ADPKD), the use of two drugs was not more effective than using a single drug in slowing disease progression, according to the results of two studies funded by the National Institutes of Health (NIH). The results of this study are published in two papers in the New England Journal of Medicine.

The HALT-PKD trial enrolled participants to test if the combination of lisinopril and telmisartan could reduce kidney cysts and slow progression of ADPKD. One study within the trial studied patients with early-stage ADPKD and relatively healthy kidneys (n=558). The other study studied patients with more advanced diseased and reduced kidney function (n=486). In both studies, patients were randomized to either lisinopril and telmisartan, or lisinopril and placebo. Results found that the addition of the second drug did not affect kidney function or rate of growth in kidney cyst size.

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Study investigators also evaluated whether decreasing blood pressure below usual target would slow disease progression and preserve kidney function in patients with early ADPKD and healthy kidneys. Results showed that patients in the lower blood pressure group (95–110/60–75mmHg) received more rigorous treatment to maintain the lower blood pressure and demonstrated a 14% decrease in kidney cyst size vs. those in the standard blood pressure group (120–130/70–80mmHg). Kidney function between the two groups was similar, showing no added clinical benefit in the lower blood pressure group.

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