My family has had autosomal dominant polycystic kidney disease for more than 100 years. It was not until my dad's generation that having that disease was not a death sentence. Because of the science and advancements of drugs and treatment, he and I have lived amazing lives. Dad passed away in 2025 at the age of 86, a good long life for any man, and I am now 67 and still walking this earth. In the 1960s, my doctor was not a fan of early diagnosis. He felt it would affect my ability to thrive as a kid, but when I turned out to be a great specimen for flag football in middle school, he agreed to have me diagnosed. At 12 years, using radioactive dye and x-rays, it was confirmed that I was the frightened owner of polycystic kidneys and liver. There is a lot to unpack in this sentence, but I shared this with you to show how far technology has come. X-rays and dye that caused most patients to vomit and harmed the very organs we were viewing were the only diagnostic tool available to us. But as the years went on, new and noninvasive diagnostic tools became available. The amount of information available to me to slow down the disease at the time of diagnosis was nonexistent, and even in my 20s, the only thing my doctor could suggest was to control my BP and maybe not drink coffee. As time went on, studies like this one added more information to my toolbox to improve or maintain my health for as long as possible. At the age of 12, I was told my lifespan was <50 years, but, as of authoring this article, I am 67 years old. I hope to live as long as my dad did. With better medications like this study shows, I just might. The study I have been asked to comment on “Efficacy, Mechanisms and Safety of Sodium-Glucose Cotransporter-2 Inhibitors in Kidney Transplant Recipients: A Randomized, Double-Blind, Placebo-Controlled Trial” had the primary objective to evaluate BP lowering with dapagliflozin.1 Secondary outcomes were iohexol-measured GFR, natriuresis, body composition, noninvasive cardiac output monitoring, arterial stiffness, heart rate variability, neurohormones, and safety in kidney transplant patients. Being a lay person, I had some difficulty absorbing the information in this study and spent quite a lot of time asking questions of folks I know who were able to help me understand. With their help and a better understanding of the metrics used, I feel this was an important and meaningful experiment for my family. The connection of polycystic kidney disease and heart disease is truly clear in my family and though few if any of us has died of heart disease, most deaths were complicated by it. Also, post-transplant onset diabetes has affected most of us, although I have remained prediabetic for 15 years, I still hold hope that my path may turn out differently. While the importance of this study is obvious, I think it is crucial to look at the possible weak points. Almost 80% of the subjects were men, and the authors attribute this to a pattern of more men getting transplants than women. From the National Kidney Foundation2 to the National Library of Medicine,3 other works have confirmed this comment. I would like to see more done to find a way to correct this inequality to half of the world's population. I want to thank all the people who have made my life and my family's lives better and are filled with hope for the next new advance that will make the life of the kidney community healthier and more productive as was planned way back in the 70s.
Robert H. Crabtree (2026) studied this question.