tag:blogger.com,1999:blog-4230162007222918868.post6561472586854814869..comments2023-09-19T05:50:03.130-04:00Comments on Renal Fellow Network: Aquaretics and PCKDGearoid McMahonhttp://www.blogger.com/profile/08049723797363526138noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-4230162007222918868.post-33776227571575852632012-11-29T11:13:00.228-05:002012-11-29T11:13:00.228-05:00Do you not think that there is a significant confo...Do you not think that there is a significant confounder here? Decreased concentrating ability is a potential early marker of renal disease and the increased output may just reflect higher fluid losses rather than any attempt to drink more in the patients with more renal function decline. <br /><br />There was a <a href="http://www.ncbi.nlm.nih.gov/pubmed/20876670" rel="nofollow">study</a> published in CJASN last year that looked at lowering urine osmolarity below that of serum to decrease ADH secretion in patients with PCKD. Increasing input to about 2.5L daily was sufficient to lower the osm. This was based on a previous rat <a href="http://jasn.asnjournals.org/content/17/8/2220.abstract?ijkey=be78aee00dea2b46dee0a10a6e409e789658785a&keytype2=tf_ipsecsha" rel="nofollow">study</a> of PCKD that found lower cyst growth in rats given enough water to suppress ADH secretion.<br /><br />I'm with you on then fact that water intake per se is not to be necessarily encouraged in patients with CKD but I think the evidence points towards a benefit in those with PCKDGearoid McMahonhttps://www.blogger.com/profile/08049723797363526138noreply@blogger.comtag:blogger.com,1999:blog-4230162007222918868.post-56628648336246797182012-11-29T10:59:32.823-05:002012-11-29T10:59:32.823-05:00Graham, check out figure 3 from this study of the ...Graham, check out figure 3 from this study of the <a href="http://www.ncbi.nlm.nih.gov/pubmed/12722030" rel="nofollow">MDRD data</a>. It showed an increase progression of CKD with increased urine output (and this was also true for patients with ADPKD as diagnosis). Makes me skeptical that water alone would work. I have a pic of the fig on this <a href="http://www.pbfluids.com/2009/04/nephrology-myths-drink-lot-of-water.html" rel="nofollow">post</a>Kidney_Boyhttps://www.blogger.com/profile/03706593315253399631noreply@blogger.comtag:blogger.com,1999:blog-4230162007222918868.post-12593385387195752942012-11-28T21:47:34.746-05:002012-11-28T21:47:34.746-05:00Great post Gearoid.
A few more questions to chew ...Great post Gearoid.<br /><br />A few more questions to chew on...<br /><br />Can we achieve the same effects by simply increasing water intake?<br /><br />I imagine vaptan therapy raises ADH levels as aquaresis leads to hypernatremia. As such, might increased water intake actually be a superior to vaptan therapy in a non-trial setting were more frequent missed doses might lead to intermittent renal exposure to high ADH levels? Graham Abrahttps://www.blogger.com/profile/10428974188364898281noreply@blogger.com