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Kidney Week

Abstract: TH-PO433

A Meta-Analysis of Placebo-Controlled Randomized Clinical Trials of Octreotide-LAR in Autosomal Dominant Polycystic Kidney Disease

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Vaidya, Satyanarayana R., Emory University School of Medicine, Atlanta, Georgia, United States
  • Rajabalan, Ajai S., Emory University School of Medicine, Atlanta, Georgia, United States
  • Rahbari-Oskoui, Frederic F., Emory University School of Medicine, Atlanta, Georgia, United States
Background

Autosomal Dominant polycystic kidney disease (ADPKD), is the most common hereditary disease of the kidneys, characterized by tubular epithelial cell proliferation (ECP) and fluid secretion (FS) leading to cystic kidney enlargement and progressive renal failure in most cases. Cyclic adenosine monophosphate (cAMP) pathway has been clearly implicated in both ECP and FS. Somatostatin and its synthetic analogues have shown to inhibit invitro adenyl cyclase activity in vitro and slow cyst growth both in few underpowered studies in either early or more advanced stages of ADPKD. This project aimed to evaluate the efficacy of Octreotide-LAR on disease progression based on a meta-analysis of published literature, across all stages of CKD due to ADPKD.

Methods

All placebo-controlled randomized trials (RCT) of Octreotide-LAR (OLAR) in ADPKD were identified through a search using the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases. A meta-analysis of efficacy (rate of cyst growth and kidney function decline) and safety outcomes was performed. Participants in those trials were adults, with clinical and ultrasound diagnosis of AKPKD with glomerular filtration rate (GFR) of ≥15 ml/min/1.73 m2, with exclusion of diabetics and poorly controlled hypertension (BP> 180/110 mmHg).. Outcomes were mean Total kidney volume (TKV) and decrease in Gfr (Ideally you want an annualized rate of eGFR decline) and were compared by using Standard mean difference (SMD).

Results

Four RCTs fulfilled the inclusion criteria, yielding 445 patients. Compared to placebo, OLAR showed a significant reduction of TKV, SMD -0.41[ 95% confidence intervals CI -0.69 to -0.12], p=0.005 but a comparable mean reduction in Gfr SMD 0.01 [95% CI -0.17 to 0.20], p=0.90 and rate of adverse events RR (risk ratio) 1.46 [0.82 to 2.61], p=0.20.

Conclusion

OLAR delays the cyst growth across all stages of kidney disease in ADPKD, without a clear beneficial effect on kidney function, or a significant difference in adverse outcomes. Longer follow up is required to elucidate a potential beneficial role of OLAR on kidney function.