A nurse is caring for a client with autosomal dominant polycystic kidney disease (ADPKD). Which nursing intervention is most appropriate to help prevent complications associated with this condition?

Blood pressure control is critical in ADPKD to slow disease progression and prevent cardiovascular complications. Other options are not recommended as they may worsen outcomes.

Understanding Autosomal Dominant Polycystic Kidney Disease (ADPKD)
ADPKD is the most common inherited kidney disorder, affecting 1 in 400 to 1,000 people worldwide ^[1]. The genetic mutation leads to the development and progressive growth of fluid-filled cysts in the kidneys, which disrupt normal kidney architecture and function. A major driver of cyst growth and the decline in kidney function is the early activation of the renin-angiotensin-aldosterone system (RAAS). The expanding cysts compress the renal vasculature, causing intrarenal ischemia. This triggers a powerful and maladaptive hemodynamic response: systemic hypertension. Hypertension is not merely a consequence of ADPKD; it is a key accelerant of disease progression. Elevated blood pressure further damages the already compromised renal vessels and contributes directly to cardiovascular complications, which are the leading cause of death in these patients. This pathophysiological link makes blood pressure control the cornerstone of therapy to preserve kidney function and prevent complications [1,2].

Analysis of Options
1. Encourage high-protein diet to maintain muscle mass: This is incorrect. A high-protein diet is not recommended in ADPKD. Increased protein intake elevates glomerular pressure and hyperfiltration, which can theoretically accelerate the decline of the glomerular filtration rate in already vulnerable kidneys. Current management focuses on avoiding excessive protein to reduce renal workload, not increasing it.

2. Restrict fluid intake to 1000 mL per day: This is contraindicated. The hormonal dysregulation in ADPKD involves a resistance to antidiuretic hormone (vasopressin). Vasopressin promotes cyst growth by driving fluid secretion into the cysts and increasing cell proliferation. The primary counter-regulatory mechanism is to suppress vasopressin release through high water intake. Patients are typically encouraged to achieve a high urine output (e.g., 3 liters per day) to keep vasopressin levels low. Fluid restriction would have the opposite effect, concentrating urine and stimulating vasopressin, thereby fueling cyst enlargement.

3. Monitor and control blood pressure within target range: This is the most appropriate intervention. The 2025 KDIGO guidelines emphasize early diagnosis and prevention, with strict blood pressure control being a primary, evidence-based measure to slow disease progression ^[1]. The ADPKD Centers of Excellence program identifies standardized care to improve outcomes, and rigorous hypertension management is a fundamental component of this specialized care model . Controlling blood pressure reduces cardiovascular risk and slows the decline in kidney function by mitigating the hemodynamic stress on the kidneys.

4. Administer diuretics to reduce kidney workload: This is generally not a first-line or primary preventive strategy for complications. While diuretics may be used cautiously to manage volume overload in later stages of chronic kidney disease, they do not target the underlying pathophysiology of ADPKD. In fact, certain diuretics could theoretically stimulate the RAAS, potentially worsening hypertension and cyst growth. The main pharmacologic intervention for rapidly progressive disease is a vasopressin V2-receptor antagonist like tolvaptan, which directly counteracts the cystogenic signaling pathway, not a standard diuretic .

Clinical Application and Rationale
The systematic review on health-related quality of life in ADPKD highlights that the disease burden extends across all chronic kidney disease stages, making proactive management to delay progression a critical nursing goal . The nurse’s role is to implement interventions that directly interrupt the pathophysiological cycle of cyst growth and vascular damage. By meticulously monitoring blood pressure and collaborating with the healthcare team to keep it within a strict target range, the nurse directly addresses the ischemia-hypertension-cyst growth cycle. This approach is the most effective nursing action to prevent the cardiovascular and renal complications that define ADPKD’s clinical course, a principle reinforced by the latest consensus guidelines and specialized care frameworks [1,2].