Abstract: PO1544
Predictors for Suppressing Polycystic Liver Progression of ADPKD by Tolvaptan
Session Information
- Cystic Kidney Diseases: Mechanisms, Genetics, and Treatment
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Genetic Diseases of the Kidneys
- 1001 Genetic Diseases of the Kidneys: Cystic
Authors
- Mizuno, Hiroki, Toranomon Byoin, Minato-ku, Tokyo, Japan
- Ubara, Yoshifumi, Toranomon Byoin, Minato-ku, Tokyo, Japan
- Hoshino, Junichi, Toranomon Byoin, Minato-ku, Tokyo, Japan
Background
Polycystic liver disease (PLD) is one of the fatal complications of ADPKD, which leads to abdominal compression, cyst infection, and liver failure. Although PLD progresses after reaching ESKD, few drugs can effectively inhibit its growth. Tolvaptan (TVP), V2 receptor antagonist, has been known to suppress the growing rate of polycystic kidney disease, but the effect on PLD has not been studied yet. In order to evaluate the tolvaptan’s effect on PLD, an observational cohort study was conducted.
Methods
ADPKD patients with PLD taking tolvaptan were enrolled in this study. Total liver volume (TLV) was measured by CT and calculated by automated calculated application, VINCENT®. Annual change of TLV (ΔTLV) was defined by the approximate slope estimated from more than two points. If the patients had some interventions including cyst drainage, surgical fenestration, and transcatheter trans-arterial embolization, the observational period was excluded for one year after such interventions. We compared ΔTLVs before and after TVP initiation, and defined “responder” as patients whose post-ΔTLV were smaller than pre-ΔTLV. Factors associated with “responder” were analyzed by the logistic regression model, adjusting sex, age, BMI, blood pressure, height adjust total kidney volume(htTKV) and ΔTLV before taking TVP(preΔTLV), by using R version 3.4.3.
Results
85 patients were eligible to this study. Median observational periods were 1.98 and 2.19 year in pre-prescription period and post-prescription period respectively. Median age was 53 years old and 31 cases were female. Median htTLV and htTKV before taking TVP was 1747[557-7432] (ml/m) and 909[226-4152] (ml/m), respectively. The reduction of ΔTLV were observed in 46 cases, who were significantly older, had higher preΔTLV and had higher rate of taking ursodeoxycholic acid. Logistic regression analysis showed older age (OR 2.60[1.36-5.72],p<0.01) and higher preΔTLV (OR 1.25[1.12-1.46],p<0.01) were the predictors of the reduction of ΔTLV.
Conclusion
In this study, more than half of ADPKD patients experienced reduction of ΔTLV after taking TVP. Our study suggests that elder age and higher pre-ΔTLV would predict the reduction of the progression of PLD after TVP use, though it was reported younger female tend to have larger PLD.