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Kidney Week

Abstract: TH-PO838

Could Glomerular Filtration Rate be an Exclusion Criteria to Initiate Tolvaptan Therapy in Those Patients with ADPKD with Risk of Rapid Progression and Predict Renal Outcomes?

Session Information

Category: Genetic Diseases of the Kidneys

  • 1001 Genetic Diseases of the Kidneys: Cystic

Authors

  • Rodriguez-Perez, Jose C., University Hospital of Gran Canaria Dr. Negrin, Las Palmas Gran Canaria, Spain
  • Fernandez, Juan Manuel, University Hospital of Gran Canaria Dr. Negrin, Las Palmas Gran Canaria, Spain
  • Rodriguez-Esparragon, Francisco Javier, Unidad de Investigación, Hptal Dr. Negrín, Gran Canaria, Spain
  • Hernández-Socorro, Carmen-Rosa, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
  • Oliva Damaso, Elena, University Hospital of Gran Canaria Dr. Negrin, Las Palmas Gran Canaria, Spain
  • Oliva-Damaso, Nestor, Hospital Costa del Sol, Marbella, Spain
  • Robador, Lucas, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
  • Porrini, Esteban, University of La Laguna, Tenerife, Spain
Background

Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent inherited renal disease and located among the four main causes of end stage renal disease (ESRD) in adult population.

Methods

To analyze the role of tolvaptan (TOLV) along time according with the initial estimated glomerular filtration rate (CKD-EPI) in those patients with CKD 1-4 with risk of rapid progression to ESRD (clinical, analytical and imaging scoring).

PATIENTS AND METHODS: This is an observational and transversal study of our first cohort of 15 pts which initiates in TOLV at a 45/15 mg/d dose and escalating every two weeks until 120 mg/d (13 pts) or maximal tolerated dose (90 mg/d (2 pts)). Controls were made initially every two weeks and every 3 months at 18 months of TOLV.

Results

At the time of inclusion all patients 45.4 +/- 6.5 years old and 83.0 +/- 14.2 kg. 65% were men and the plasma creatinine were 0.98 to 2.58 mg/dl with a CKD-EPI of 53.3 +/- 23 ml/min (25.6 to 102.3). Total kidney volume adjusted for age and height ranged from 997 to 2634 cc. After being log-transformed GFR was normally distributed and parametric comparison was made. All treated patients showed a reduction in their GFR in correlation with the used doses (p=0.002). Since in the previous comparison de-escalation patients were included, patients were distributed in quartiles of GFR excluding filtering values corresponding to de-escalated doses as follows: (< 30 ml/min: 2 pts; 30-44 ml/min: 5 pts; 45-60 ml/min: 4 pts and >60 ml/min: 4 pts). In this analysis we do not show any correlation between GFR and TOLV treatment, even after one year of therapy. These data are in agreement with the REPRISE study (Torres V et al, NEJM 2017) results. In any of the quartile established we cannot find any significant relation between TOLV treatment, dose of TOLV and reduction of GFR.

Conclusion

The use of TOLV seems to be safe and effective even in those patients older than 50 years and with CKD stage 3b-4. Those patients with a GFR less than 30 ml/min must be on a one-to-one basis evaluated.

Funding

  • Private Foundation Support