APPROACH TO THE DIAGNOSIS AND MANAGEMENT OF ADPKD : AN INDIAN, BANGLADESH AND SRILANKAN PERSPECTIVE -A SURVEY STUDY

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APPROACH TO THE DIAGNOSIS AND MANAGEMENT OF ADPKD : AN INDIAN, BANGLADESH AND SRILANKAN PERSPECTIVE -A SURVEY STUDY

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Co-author 1

Krithika Mohan krithicism@gmail.com Cytecare hospitals Nephrology Bangalore India -

Co-author 2

Arvind C canchi8@gmail.com Trustwell hospitals Nephrology Bangalore India -

Co-author 3

Muhammad Rafiqul Alam alammrdr@gmail.com BSMMU Nephrology Dhaka Bangladesh -

Co-author 4

Dilushi Wijayaratne dilushi_w@yahoo.com University of Colombo Clinical medicine Colombo Sri Lanka -

Co-author 5

Sundar Swaminathan swami@iisc.ac.in Division of Medical Sciences, Tata-IISc Medical School Nephrology Bangalore India *

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Introduction

ADPKD (Autosomal dominant polycystic kidney disease) is a genetic disease characterised by development of fluid filled cysts in the kidneys, leading to kidney enlargement and dysfunction. The economic capability of the patient drives the approach to diagnosis and treatment of ADPKD patients. We present an analysis of a recent survey that we conducted to understand ADPKD practice patterns among nephrologists in India, Bangladesh and Sri Lanka.

Methods

The survey included 22 questions capturing basic details, methods used for screening, confirmation and prognostication of ADPKD and treatment options and targets in these patients. The survey was sent out via whatsapp groups and email to state and national nephrology groups. Participants had 30 days to respond.

Results

A total of 345 nephrologists responded to the survey.

Key findings include

Ultrasound was the main mode of initial diagnosis of PKD and to screen family members.

In accordance with the KDIGO guidelines, 2/3 of the Indian respondents asked for a TKV and used the Mayo classification compared to a 2/5 in Bangladesh and 1/3 in Sri Lanka.

Genetic tests were done by 16% of Indians and 5% of Bangladeshi and none of Sri lankan patients to determine prognosis.

Only 5.5% of the respondents used the KDIGO set BP target of <110/70 mm Hg when treating their PKD patients.

40% used lower than recommended doses while initiating patients on Tolvaptan Table 2 Table1 tan.

Conclusion

Our survey identified several deviations from recommended KDIGO protocols in delivering optimal care to patients with PKD. It is widely recognized that there is often a lag between published protocols and translation and uptake of this into daily practice. The landscape of treatment of ADPKD is evolving with many novel therapies being identified. Perhaps focussed training, integrated approach and standardisation of protocols may help streamline investigations and guide better management of patients with PKD.

Kewords