Kidney Week

Abstract: SA-PO0105

Effect of Tolvaptan on Kidney Function Decline in Chinese Patients with ADPKD: A Single-Center, Dose-Stratified, Before-and-After Study

Session Information

• ADPKD and Cystic Kidney Disease - 3
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Genetic Diseases of the Kidneys

• 1201 Genetic Diseases of the Kidneys: Cystic (Monogenic)

Authors

• Chen, Xiaowei, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China

Xiaowei Chen, MBBS

• Ma, Xuejuan, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China

Xuejuan Ma, MD

• Pai, Pearl, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China

Pearl Pai, MD, MBChB

• Xiangyang, Li, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China

Li Xiangyang, MD

• Cui, Liwen, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China

Liwen Cui, PhD

• Wang, Gang, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China

Gang Wang

• Ma, Becky Mingyao, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong

Becky Mingyao Ma, MBBS

Group or Team Name

• Division of Nephrology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital

Background

Tolvaptan slows kidney function decline in Autosomal Dominant Polycystic Kidney Disease (ADPKD) patients, yet real–world, dose–dependent effect on eGFR decline slope remains poorly characterized. Only Samsca instead of Jinarc is accessible in China, on a self-financed basis.

Methods

44 Chinese ADPKD patients on steady dose tolvaptan for longer than three months were analyzed. Serial eGFR measurements from 144 weeks before to 96 weeks after treatment initiation were analyzed using linear mixed–effects models (random intercept and slope), adjusting for baseline eGFR. Change in annual eGFR decline slope before and after tolvaptan use was studied. Patients were stratified by steady total daily dose into low (<30 mg), medium (30–59 mg), and high (≥60 mg) dose groups.

Results

The majority of ADPKD patients were on <60mg steady total daily dose (n=36, 81.8%). Major reason limiting up-titration was financial restraint (n=18, 50%), followed by thirst (n=6, 16.7%). The cohort's pre–treatment and on–treatment eGFR decline slope were –6.50 and –5.34 mL/min/1.73m²/year respectively (p=0.49). When stratified by dose, eGFR decline slope slowed by 0.8, 3.7, and 3.8 mL/min/1.73 m²/year respectively in the low, medium, and high dose groups (p=0.35).

Conclusion

The majority of ADPKD patients were on <60mg steady total daily dose of tolvaptan and up-titration was mainly limited by financial constraint. Tolvaptan use was associated with a numerically slowing in eGFR decline slope, particularly in medium to high dose groups, though statistical significance was not reached.