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Letter to the Editor
Comments on the consensus document on autosomal dominant polycystic kidney disease of the SENefro
Comentarios sobre el Documento de consenso de poliquistosis renal autosómica dominante de la SENefro
José Ignacio Minguela
Corresponding author
Servicio de Nefrología, Hospital Universitario Basurto, Bilbao, Bizkaia, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I have read the Consensus Document on Autosomal Dominant Polycystic Kidney<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> that the Spanish Society of Nephrology &#40;Sociedad Espa&#241;ola de Nefrolog&#237;a&#44; SEN&#41; drafted and published on its website and I would like to make some of comments on what has been exposed in that document&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">They are based on the lack of definition of the term &#8220;rapid progressor&#8221; by the EMA<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> to establish some criteria that seem to me to be inaccurate&#46; Anyone who starts renal replacement therapy before the mean global age for starting renal replacement therapy in Spain &#40;65 years old&#41; is considered a rapid progressor&#46; If a disease takes an average of X years to reach the terminal stage&#44; the rapid progressors would be all those patients who reach that point before that X average&#44; and slow progressors&#44; who last longer than the average for that process&#46; I believe that the overall average age at initiation of renal replacement therapy should not be used as a reference point since other diseases present at more advanced ages &#40;diabetic nephropathy and nephroangiosclerosis&#41; have an impact and therefore increase that average age&#46; According to the logic used by the authors&#44; it could also be said that any person who starts dialysis before the average life expectancy of the general population &#40;80&#46;6 years in men and 86 in women before the pandemic&#41;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> is a rapid progressor&#46; Therefore most of our patients could be included in that definition&#46; In type 1 polycystic kidney disease&#44; the average onset of end-stage kidney failure is 54 years old&#44;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> and that should be&#44; in my opinion&#44; the point at which a person with polycystic disease is considered a rapid or slow progressor&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In addition&#44; it is suggested to start treatment with tolvaptan in patients until 60 years old&#46; I have only seen one study<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> &#40;REPRISE&#41; including patients &#62;55 years&#46; In that study&#44; in the subgroup of patients &#62;55 years old&#44; the difference in progression was similar with respect to the placebo group &#40;GFR drop&#58; 2&#46;54 vs 2&#46;34<span class="elsevierStyleHsp" style=""></span>ml&#47;min &#91;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;65&#93;&#41;&#46; The study included a limited number of patients&#44; but no other study affirms otherwise&#59; therefore&#44; no treatment should be started at these ages outside of a controlled clinical trial&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">I believe that the society allows us to manage public funds&#44; that are limited&#44; with a commitment to maximum efficiency&#46; That means using them in those cases in which these treatments are truly useful&#46; If we cannot manage these funds&#44; we will totally lose the capacity of managing them&#46;</p></span>"
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Article information
ISSN: 20132514
Original language: English
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Idiomas
Nefrología (English Edition)