Prevalence of Inferior Vena Cava Compression in ADPKD

Xiaorui Yin; Jon D Blumenfeld; Sadjad Riyahi; Xianfu Luo; Hanna Rennert; Irina Barash; Martin R Prince

doi:10.1016/j.ekir.2020.10.027

Prevalence of Inferior Vena Cava Compression in ADPKD

Kidney Int Rep. 2020 Nov 1;6(1):168-178. doi: 10.1016/j.ekir.2020.10.027. eCollection 2021 Jan.

Authors

Xiaorui Yin^{1

2}, Jon D Blumenfeld^{3

4}, Sadjad Riyahi¹, Xianfu Luo¹, Hanna Rennert⁵, Irina Barash^{3

4}, Martin R Prince^{1

6}

Affiliations

¹ Department of Radiology, Weill Cornell Medicine, New York, New York, USA.
² Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³ The Rogosin Institute, New York, New York, USA.
⁴ Department of Medicine, Weill Cornell Medicine, New York, New York, USA.
⁵ Department of Pathology, Weill Cornell Medicine, New York, New York, USA.
⁶ Department of Radiology, Columbia College of Physicians and Surgeons, New York, New York, USA.

Abstract

Introduction: Kidney and liver cysts in autosomal dominant polycystic kidney disease (ADPKD) can compress the inferior vena cava (IVC), but IVC compression prevalence and its risk factors are unknown.

Methods: Patients who have ADPKD (n = 216) with abdominal magnetic resonance imaging (MRI) studies and age-/sex-matched controls (n = 216) were evaluated for IVC compression as well as azygous vein diameter (a marker of collateral blood flow) and IVC aspect ratio (left-to-right dimension divided by anterior-to-posterior dimension with a value of 1 corresponding to a circular (high pressure) IVC caudal to compression.

Results: Severe IVC compression (≥70%) was observed in 33 (15%) ADPKD subjects and mild compression (≥50% to <70%) was observed in 33 (15%) subjects; whereas controls had no IVC compression (P < 0.001). Severe IVC compression was associated with larger azygous vein (4.0 ± 1.3 mm versus 2.3 ± 0.8 mm without IVC compression; P < 0.001) and a more circular IVC cross-section upstream (mean IVC aspect ratio: 1.16 ± 0.27 vs. 1.69 ± 0.67, P < 0.001), suggesting higher pressure upstream from the compression. IVC compression was associated with older age, lower estimated glomerular filtration rate (eGFR), greater height-adjusted total kidney volumes, greater height-adjusted liver volume (ht-LV), and greater liver and renal cyst fractions (P < 0.001). No subject younger than 30 years had IVC compression, but ADPKD subjects ≥40 years old had 12-fold higher risk of IVC compression (95% confidence interval [CI]: 4.2-42.4), with highest predicted probability for Mayo Clinic classes 1D (59%; 95% CI: 39%-76%) and 1E (74%; 95% CI: 49%-90%) after adjustment (P < 0.001). Women with ht-LV ≥ 2000 ml/m had 83% (95% CI: 59%-95%) prevalence of IVC compression. Complications of IVC compression included deep vein thrombosis (DVT) and symptomatic hypotension.

Conclusions: IVC compression is common in ADPKD patients >40 years old, with Mayo Clinic class 1D/E, and in females with ht-LV > 2000 ml/m.

Keywords: ADPKD; DVT; IVC compression; Mayo Clinic Classification; azygos vein; hypotension.

Grants and funding

UL1 TR002384/TR/NCATS NIH HHS/United States