PKD Life - Fall 2020 - 11

DOCTOR Q&A

Cardiovascular
Disease and ADPKD

Insights and advice from nephrologist Meyeon Park, M.D.

spoke to Meyeon Park, M.D., director of the
W ePolycystic
Kidney Disease Center of Excellence

at UCSF Health in San Francisco, about cardiovascular
disease. It strikes in people with autosomal dominant
polycystic kidney disease (ADPKD) at a much younger
age than in those without the condition and is one of the
most common causes of death in people with ADPKD.

How do heart disease
and kidney disease
influence each other?
Kidney disease and heart
disease are linked in both
directions. Heart disease can
be associated with kidney
disease and vice versa. But it
takes on a slightly different
angle in PKD because the
genetic problems associated with the kidney in PKD
can also affect various heart
structures, including the
valves, aortic wall strength,
and pericardial space, where
fluid may accumulate around
the heart. We think the same
genes responsible for PKD
are also important in the
cardiovascular system. That's
why we see that in certain
families with PKD there is a
greater likelihood of aortic
aneurysm and heart valvular
problems. But the associations and pathways are not
as well understood as the

protein problem that causes
the kidney disease.
So we start thinking about
heart disease in people with
PKD early in their disease,
whereas people with traditional kidney disease don't
typically experience cardiovascular problems until later
in their disease.

KIRILLM/GETTY IMAGES

What should
people with PKD
do to improve their
cardiovascular health?
It's important to be in great
cardiovascular shape as
early as possible to protect
against the consequences
that can occur as PKD worsens and impacts the heart.
That includes minimizing
unhealthy processed food
consumption, participating in a rigorous exercise
program, and maintaining a
healthy weight. It's best to put
these important foundations

for heart health into place
as soon as possible. As the
kidney disease progresses in
the later stages, it's harder
to reverse any heart disease,
particularly after dialysis or a
kidney transplant.
What is happening
in the world of
research around PKD and
cardiovascular health?
There is a lot going on to
understand how best to
improve the health of those
with PKD. There's a question as to whether the statin
cholesterol-lowering drugs
are important at different
stages of chronic kidney
disease. This is still being
investigated on a biological
level, but there are reasons to
think they have advantages
for kidney disease, not just
heart disease.
Also, the optimal strategy
for dealing with cardiovascular risk and kidney transplant
recipients is continually
being studied because cardiovascular disease is the No. 1
cause of death in kidney
transplant recipients.
Finally, the link between
metabolic disease, weight,
and PKD is an exciting area of
research that may lead us to
a better understanding of the
best ways to reduce cardiovascular and kidney risk in
people with PKD.

Tell us a bit about
the Center of
Excellence you lead.
We see more than 150
patients annually from across
the Bay Area and beyond and
have experienced tremendous
growth since opening in 2015.
We have a multidisciplinary
team that focuses on the
"whole patient" and spends
time discussing lifestyle and
diet. We also have a dedicated,
PKD-focused acupuncturist
with whom I collaborate to
care for patients who benefit
from this approach. Our program provides focused oversight to ensure that people
with PKD have a smooth
kidney transplant experience
when needed.
We also have a unique PKDfocused fellowship program
built into our nephrology
fellowship training program.
Our second trained fellow
just graduated after receiving
focused training in clinical
and academic aspects of PKD,
assisting with research and
participating in professional
opportunities; our third fellow
recently started the program
in July 2020.
Finally, we are actively
involved in clinical trials
for PKD and have ongoing
clinical-translational projects
with collaborators in the
basic science research world
at UCSF.

F I N D A P K D C L I N I C N E A R Y O U B Y V I S I T I N G P K D C U R E .O R G / F I N D - A - C L I N I C

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9/23/20 9:54 AM

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PKD Life - Fall 2020

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