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Kidney Week

Abstract: SA-PO478

Clinical Features Expecting High Efficacy of Tolvaptan in ADPKD Patients

Session Information

  • ADPKD: Clinical Studies
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Genetic Diseases of the Kidney

  • 1001 Genetic Diseases of the Kidney: Cystic

Authors

  • Kogure, Yuta, Saitama Medical Center, Saitama Medical University, Saitama, Japan
  • Takayanagi, Kaori, Saitama Medical Center, Saitama Medical University, Saitama, Japan
  • Sato, Mariko, Saitama Medical Center, Saitama Medical University, Saitama, Japan
  • Shimozato, Yu, Saitama Medical Center, Saitama Medical University, Saitama, Japan
  • Hirose, Kento, Saitama Medical Center, Saitama Medical University, Saitama, Japan
  • Yasuda, Kunihiko, Saitama Medical center, Saitama Medical University, Kawagoe, Japan
  • Shioda, Yuya, Saitama Medical center, Saitama Medical University, Kawagoe, Japan
  • Hatano, Minoru, Saitama Medical Center, Saitama Medical University, Saitama, Japan
  • Ogawa, Tomonari, Saitama Medical Center, Saitama Medical University, Saitama, Japan
  • Kanozawa, Koichi, Saitama Medical Center, Saitama Medical University, Saitama, Japan
  • Hasegawa, Hajime, Saitama Medical Center, Saitama Medical University, Saitama, Japan
Background

Clinical efficacy of tolvaptan is variable in individual ADPKD patient. In our facility, we manage 120 ADPKD patients at present, and adapt 49 patients to the tolvaptan therapy. Among the cases, 40 patients have been proceeded more than one year after induction to the therapy, they are enabled to be examined the efficacy of tolvaptan. When the effectiveness would be defined as the reduction of total kidney volume (TKV) or the annual expansion rate of kidney volume (kidney growth rate: KGR) being less than 5%, tolvaptan showed approximately 70% of effectiveness in our facility. In this study, we retrospectively studied common clinical features in ADPKD patients who showed higher efficacy to tolvaptan by primarily focusing on KGR.

Methods

Forty ADPKD patients who had been treated with tolvaptan for at least one year were included in this study. KGR was calculated by CT-based total kidney volume (TKV) at one-year prior, just before, and one-year passed to the therapy. Response to tolvaptan was determined by ΔKGR (subtraction of pre-KGR from post-KGR), and negative value of ΔKGR indicates that the increase in TKV was inhibited by tolvaptan. Enrolled patients were stratified into 3 groups by ΔKGR value, and multiple clinical parameters were compared between 1st tertile group (1TG, lowest ΔKGR indicating highly effective) and 3rd tertile group (3TG, highest ΔKGR indicating poorly effective).

Results

ΔKGR values in 1TG and 3TG were -16.9% and 13.3%, respectively. Baseline values of TKV, KGR, systolic blood pressure (SBP), body mass index (BMI) and eGFR were significantly different between 1TG and 3TG (median TKV: 2005 mL vs 2534 mL, median KGR: 18.4% vs 3.0%, SBP: 123.1±16.5 mmHg vs 133.9±17.7 mmHg, BMI: 22.5±4.0 vs 26.3±7.4, eGFR: 57.1±23.7 mL/min vs 40.5±14.1 mL/min).

Conclusion

Present study may indicate that ADPKD patients who show less TKV, higher KGR, lower blood pressure, not-obese and renal function is not severely damaged would be expected higher efficacy of tolvaptan.