Abstract
Background
A recent study demonstrated that tolvaptan slowed estimated glomerular filtration rate (eGFR) decline in later-stage autosomal dominant polycystic kidney disease (ADPKD) patients. However, Japanese patients were not included in that trial, therefore tolvaptan’s efficacy in Japanese patients with advanced chronic kidney disease (CKD) has remained unknown.
Methods
In this prospective cohort study, 54 patients with ADPKD who had eGFR ≥ 15 ml/min/1.73 m2 and total kidney volume (TKV) ≥ 750 ml were treated with tolvaptan. The primary endpoint was the change in height-adjusted total kidney volume (htTKV) and eGFR after 1-year treatment with tolvaptan. Then, we compared the primary endpoint between later CKD stage (baseline eGFR < 45 ml/min/1.73 m2) and earlier CKD stage (baseline eGFR ≥ 45 ml/min/1.73 m2).
Results
The rate of kidney growth during the 1-year treatment did not differ significantly between earlier and later CKD stages. The median and interquartile range of relative change in htTKV in later CKD stage was 8.2%/year [4.4, 26.6], as compared with 5.7%/year [1.6, 16.4] in earlier CKD stage (p = 0.17). Nor did the rate of eGFR decline between earlier and later CKD stages. The relative annual change in eGFR in later CKD stage was − 9.7%/year [− 15.9, − 2.1], as compared with − 6.8%/year [− 11.1, 0.1] in earlier CKD stage (p = 0.18).
Conclusion
This analysis indicates that the efficacy of tolvaptan for Japanese patients with later stage ADPKD was not significantly different from that of Japanese patients with earlier stage ADPKD.
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Acknowledgements
This work was supported by JH’s research grants from Grants-in-Aid for Scientific Research (JSPS KAKENHI) Grant number 15K08719 and 18K08227, the Okinaka Memorial Institute, The Kidney Foundation Japan (JKFB 15–23), and Toranomon Hospital. No funding bodies had any role in study design, data analysis, decision to publish, or preparation of the manuscript.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee at which the studies were conducted (IRB approval number 840) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Oguro, M., Kogure, Y., Hoshino, J. et al. Tolvaptan in Japanese patients with later-stage autosomal dominant polycystic kidney disease. J Nephrol 31, 961–966 (2018). https://doi.org/10.1007/s40620-018-0545-8
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DOI: https://doi.org/10.1007/s40620-018-0545-8