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Abstract: TH-PO370

Tolvaptan Use at a Large PKD-Focused Program

Session Information

Category: Genetic Diseases of the Kidneys

  • 1101 Genetic Diseases of the Kidneys: Cystic

Authors

  • Chao, Allen, University of California San Francisco, San Francisco, California, United States
  • Gao, Ying, University of California San Francisco, San Francisco, California, United States
  • Jiang, Jordan, University of California San Francisco, San Francisco, California, United States
  • Osunde, Adesuwa N., University of California San Francisco, San Francisco, California, United States
  • Etwaru, Diana, University of California San Francisco, San Francisco, California, United States
  • Varanasi, Laalasa, University of California San Francisco, San Francisco, California, United States
  • Gluck, Stephen L., University of California San Francisco, San Francisco, California, United States
  • Park, Meyeon, University of California San Francisco, San Francisco, California, United States
Background

We are a center that provides multidisciplinary care for patients with autosomal dominant polycystic kidney disease (PKD). We sought to evaluate current tolvaptan use and reasons for tolvaptan discontinuation at our center.

Methods

We used the Jynarque Risk Evaluation Mitigation System database to determine tolvaptan prescriptions for patients registered through our clinic. We used our clinic database to derive clinical and demographic characteristics of these patients. We compared characteristics of individuals who were actively taking tolvaptan with those who were prescribed tolvaptan but were not taking it using t-test and chi-square.

Results

67 patients prescribed tolvaptan were identified. 36 (57.3%) were women. 49 (73.1%) were White, 1 (1.5%) were Black, 9 (13.4%) were Asian, 5 (7.5%) were Latinx, 3 (4.5%) were Other race category. Age range was 22 to 72 years; median age (IQR) 45 (39, 53). 24 (58.5%) were on therapy for longer than 18 months. Among active patients, 34 (83%) were on the 45/15mg dose; 4 (10%) on 60/30mg; 3 (7%) on 90/30mg. 26 (38.8%) were inactive. Reasons for inactivity included 4 who never started. Discontinuation occurred due to aquaretic symptoms (4); reached transplant (2); acute kidney injury (2); insurance (2); "got tired of it" (2); liver function test abnormalities (1); pregnancy (1); gastrointestinal symptoms (1); the remainder had no specific reason (7). There was no difference between eGFR at time of initiation between active and inactive groups (67 v. 58 ml/min/1.72m2); family history of PKD (88% versus 77%); or Mayo classification (Table). Those without Mayo classification had ultrasound lengths > 16.5 cm.

Conclusion

Reasons for tolvaptan discontinuation cannot be immediately identified based on clinical or demographic characteristics. Physicians should work with patients who would benefit from tolvaptan to overcome potential barriers to continued use of this medication.

Mayo Class by Active (left column) versus Inactive (right column) status (Number of patients (%))
1A1 (2.9%)1 (5.6%)
1B4 (11.8%)1 (5.6%)
1C11 (32.4%)4 (22.2%)
1D11 (32.4%)4 (22.2%)
1E6 (17.7%)4 (22.2%)