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Kidney Week

Abstract: TH-PO837

Relationship of Tolvaptan Dose with the Rate of Decline in Kidney Function in ADPKD Patients

Session Information

Category: Genetic Diseases of the Kidneys

  • 1001 Genetic Diseases of the Kidneys: Cystic

Authors

  • Akihisa, Taro, Tokyo Women's Medical University, Tokyo, Japan
  • Kataoka, Hiroshi, Tokyo Women's Medical University, Tokyo, Japan
  • Makabe, Shiho, Tokyo Women's Medical University, Tokyo, Japan
  • Tsuchiya, Ken, Tokyo Women's Medical University, Tokyo, Japan
  • Nitta, Kosaku, Tokyo Women's Medical University, Tokyo, Japan
  • Mochizuki, Toshio, Tokyo Women's Medical University, Tokyo, Japan
Background

Vasopressin receptor 2 antagonist, tolvaptan (TLV), has been shown to suppress the decline in kidney function and increase in total kidney volume in patients with autosomal dominant polycystic kidney disease (ADPKD). TEMPO 3:4 trial and REPRISE trial demonstrated that TLV suppressed the decline in kidney function. However, the dose of TLV and its relationships to kidney function decline have not been clarified. Therefore, we analyzed the TLV doses in ADPKD patients at our hospital, who were introduced to TLV, and the rate of eGFR decline after starting TLV.

Methods

The subjects were 57 patients who were administered TLV for at least 6 months at Tokyo Women’s Medical University Hospital from September 2014 to December 2017. For patients who stopped the drug due to liver dysfunction, the observation period was until they discontinued the drug. TLV dose was calculated by dividing the accumulated dose that was actually prescribed by the number of administration days during the follow-up period. The primary outcome was Δ%eGFR during the follow-up period.
The median value was calculated and logistic regression analysis was performed on the decreased kidney function group whose Δ%eGFR were less than the median value.

Results

There were 34 men and 23 women. The follow-up period was 2.1 years, age at start of administration was 41, TKV was 2,023.54 mL, and eGFR was 42.3 mL/min/1.73 m2 (all median values). For CKD stage, there were 3 patients of G1, 11 patients of G2, 29 patients of G3, and 14 patients of G4. For the Mayo classification, there were 3 patients of class 1B, 21 patients of 1C, 20 patients of 1D, and 13 patients of 1E. The accumulated dose was 63.5 mg/day, and ΔeGFR was -4.3 mL/min/1.73 m2 /year, Δ%eGFR was -11.0%.(all median values).
The multivariate logistic analyses included age, sex, eGFR, hemoglobin, urinary osmolality the day after administration, accumulated dose of TLV, hypertension, hyperuricemia, determined that age (P <0.05) , and accumulated dose of TLV (P <0.05) were independently associated with a decreased kidney function.

Conclusion

Increasing the TLV dose appears to suppress the decline in kidney function in ADPKD patients.