Autosomal dominant polycystic kidney disease
ICD-10 Q61.2 · ICD-11 GB81

Autosomal Dominant Polycystic Kidney Disease: What to Do When First-Line RASi and Lifestyle Therapy Fails to Reach Blood Pressure Targets

Blood pressure control is a central management priority in autosomal dominant polycystic kidney disease (ADPKD). This protocol applies when the recommended first-line approach has been tried and the blood pressure target has not been achieved.

First-Line Treatment — Goals Not Reached

The initial approach — healthy dietary and lifestyle modifications (including reduced sodium intake, weight optimisation, and regular exercise) combined with a renin-angiotensin system inhibitor (RASi): either an ACE inhibitor (ACEi) or an angiotensin II receptor blocker (ARB) — did not achieve the required blood pressure target. The targets that were not met: ≤110/75 mm Hg in adults aged 18–49 with CKD stages G1–G2, or a mean systolic blood pressure of <120 mm Hg in adults aged 50 and over.

Next-Line Approach

The protocol for this situation involves adding a further antihypertensive agent, with therapy tailored to the individual patient — aiming to reach the recommended blood pressure target. The complete structured regimen is available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.kint.2024.07.010

Optimize BP with a 2nd-line agent, if needed.

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