Excess Weight and the Kidney’s Blood Supply: A New Clue in ADPKD Progression

Dr Sourabh Sharma, Department of Nephrology, SMS Medical College and Hospital, Jaipur

Overweight and obesity were associated with progressively lower renal blood flow in early-stage ADPKD.

Autosomal dominant polycystic kidney disease (ADPKD) is a frequently encountered inherited renal disorder. It is characterized by the growth of numerous fluid-filled cysts, which cause progressive kidney enlargement, destruction of functional renal tissue, and an eventual decline in kidney function. Progression is monitored through increases in total kidney volume (TKV), although the factors driving faster kidney growth are not fully understood.

Overweight and obesity have been associated with greater annual TKV growth, faster eGFR decline, and a higher risk of end-stage kidney disease in early-stage ADPKD. Renal blood flow (RBF) supports glomerular filtration and oxygen transport to the kidneys, and changes in renal microcirculation have been observed in ADPKD before any detectable decline in eGFR. Despite this, the relationship between body mass index (BMI) and RBF has not been thoroughly investigated.

To address this, researchers conducted a cross-sectional analysis of 134 non-diabetic adults with ADPKD and an eGFR ≥60 mL/min/1.73 m², all of whom had also participated in a randomized controlled trial of pravastatin. Participants were then grouped as normal weight, overweight, or obese. BMI was adjusted by subtracting MRI-derived kidney and liver mass from body weight. RBF was measured by phase-contrast MRI.

RBF was lower with each increasing BMI category. This association persisted after adjustment for demographics, blood pressure, blood glucose, HDL cholesterol, antihypertensive use, eGFR, and kidney volume. Each one-unit increase in BMI was associated with an RBF approximately 10 mL/min/1.73 m² lower.

Given the cross-sectional design, the data indicate an association rather than causality. The authors call for longitudinal studies to establish the temporal and causal nature of this relationship.

(Reference: Birznieks CL, Wang W, Steele C, You Z, Gitomer B, Chonchol M, Nowak KL. Overweight and obesity are associated with lower renal blood flow in autosomal dominant polycystic kidney disease. Kidney and Blood Pressure Research. 2026 Mar 30;51(1):218-24.)