TAE or not TAE: the conclusions of one study on whether transcatheter arterial embolisation of the renal arteries improves the quality of life in APKD patients

One of the options for reducing kidney volume in ADPKD is to block the arterial blood supply to parts of the kidney – called ‘transcatheter arterial embolisation’ (TAE). I don’t know how commonly this is performed, but presume it is an option used as a last resort for very large kidneys and multiple symptoms caused by the mass effect. This month in the academic journal ‘Nephrology, Dialysis and Transplant’ there is a report from a Japanese study of 188 patients who experienced TAE.  

The investigators, from one hospital in Tokyo, selected 92 men and 96 women on haemodialysis who all underwent an embolisation procedure. They assessed the patient quality of life, before and one year after the treatment, using the Short Form Survey (SF-36). This health assessment tool is well known and has been validated and is able to separate physical, mental and social elements to a certain degree. The study states the average scores obtained for the group as a whole and for the separate elements of physical, mental and social. I am not experienced in scoring for this SF-36 but you can get details on it from the rand.org website. In a nutshell an increase in scores represents an improvement in the quality of life. 
After the TAE scores for all three elements improved. Specifically abdominal fullness, poor appetite and heartburn were all reduced by the procedure. There were slight improvements in the scores for fever, pain and sleep. However constipation, use of laxatives and use of analgesics did not change. So thats a bit of a mixed result. They were able to correlate the improvements with reductions in the height-adjusted total kidney volume which is promising.  
One of the problems with assessing benefits in this kind of procedure is that no two surgical procedures are alike and one person may have a greater reduction in total kidney volume compared with another despite an apparently identical approach. And how do you compare the effect of constipation on quality of life with the effect of heartburn on quality of life – you and I might have a very different response to those situations. One of the SF-36 scores considers snoring – well the frustrations from that might turn on whether you sleep alone or have a partner! 
But all that aside, it does look as if this study confirms that TAE is beneficial for dialysis ADPKD patients suffering from fullness, heartburn and reduced appetite. 
I would be interested in comparisons of outcomes for renal arterial embolisation or nephrectomy of native kidneys – though the latter is clearly a more complex procedure, one might presume it to generate a greater improvement in quality of life for ADPKD patients with grossly enlarged kidneys. 

Tatsuya Suwabe, Yoshifumi Ubara, Akinari Sekine et al. Effect of renal transcatheter arterial embolisation on quality of life in patients with autosomal dominant polycystic kidney disease. Nephrol Dial Transplant (2017) 32 (7): 1176-1183 [published 30 June 2017]


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