Publication:
Real clinical experience after one year of treatment with tolvaptan in patients with autosomal dominant polycystic kidney disease.

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Date

2022-08-31

Authors

Naranjo, Javier
Borrego, Francisco
Rocha, Jose Luis
Salgueira, Mercedes
Martin-Gomez, Maria Adoracion
Orellana, Cristhian
Morales, Ana
Vallejo, Fernando
Hidalgo, Pilar
Rodriguez, Francisca

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Frontiers Research Foundation
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Abstract

Tolvaptan (TV) is the first vasopressin-receptor antagonist approved for the treatment of autosomal dominant polycystic kidney disease (ADPKD). No publications report TV experience in real clinical practice during the first year of treatment. A prospective study of an initial cohort of 220 rapidly progressing patients treated with TV for 12 months. The tolerability of TV, the evolution of the estimated glomerular filtration rate (eGFR), analytical parameters, and blood pressure were analyzed. A total of 163 patients (78.2%) received TV for 1 year. The main causes of treatment withdrawal were the aquaretic effects (11%), eGFR deterioration (5%), and hepatic toxicity (2.3%). eGFR decreased significantly after 1 month of treatment without further changes. The decrease in eGFR in the first month was higher in patients with an initially higher eGFR. The eGFR drop during the first year of treatment with TV was lower than that reported by patients in the 2 years prior to TV treatment (-1.7 ± 7.6 vs. -4.4 ± 4.8 mL/min, p = 0.003). Serum sodium and uric acid concentrations increased, and morning urinary osmolality decreased in the first month, with no further changes. Blood pressure decreased significantly without changes in antihypertensive medication. TV treatment is well tolerated by most patients. Liver toxicity is very rare and self-limited. TV reduces eGFR in the first month without showing further changes during the first year of treatment. Patients with a higher starting eGFR will suffer a greater initial drop, with a longer recovery. We suggest using the eGFR observed after a month of treatment as the reference for future comparisons and calculating the rate of eGFR decline in patients undergoing TV treatment.

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MeSH Terms

Humans
Tolvaptan
Antidiuretic Hormone Receptor Antagonists
Polycystic Kidney, Autosomal Dominant
Prospective Studies
Antihypertensive Agents
Blood Pressure
Uric Acid
Glomerular Filtration Rate
Hepatitis
Osmolar Concentration
Vasopressins
Sodium

DeCS Terms

Antagonistas de los receptores de hormonas antidiuréticas
Antihipertensivos
Concentración osmolar
Estudios prospectivos
Hepatitis
Humanos
Presión sanguínea
Riñón poliquístico autosómico dominante
Sodio
Tasa de filtración glomerular
Tolvaptán
Vasopresinas
Ácido urico

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Keywords

glomerular filtration rate (eGFR), hepatic toxicity, polycystic kidney disease (PKD), tolvaptan, urinary osmolality

Citation

Naranjo J, Borrego F, Rocha JL, Salgueira M, Martín-Gomez MA, Orellana C, et al. Real clinical experience after one year of treatment with tolvaptan in patients with autosomal dominant polycystic kidney disease. Front Med (Lausanne). 2022 Sep 29;9:987092.