RT journal article
T1 Real clinical experience after one year of treatment with tolvaptan in patients with autosomal dominant polycystic kidney disease
A1 Naranjo Muñoz, Javier
A1 Borrego, Francisco
A1 Rocha, José Luis
A1 Salgueira Lazo, Mercedes
A1 Martín-Gomez, Maria Adoración
A1 Orellana, Cristhian
A1 Morales, Ana
A1 Vallejo, Fernando
A1 Hidalgo, Pilar
A1 Rodríguez, Francisca
A1 Garófano, Remedios
A1 González, Isabel
A1 Esteban, Rafael
A1 Espinosa, Mario
A1 Andalusian Group of ADPKD and Hereditary Kidney Diseases
A2 Medicina
K1 glomerular filtration rate (eGFR)
K1 hepatic toxicity
K1 polycystic kidney disease (PKD)
K1 tolvaptan
K1 urinary osmolality
AB Background: Tolvaptan (TV) is the first vasopressin-receptor antagonist approved for the treatment of autosomal dominant polycystic kidney disease (ADPKD). No publications report TV experience in real clinical practice during the first year of treatment.Methods: A prospective study of an initial cohort of 220 rapidly progressing patients treated with TV for 12 months. The tolerability of TV, the evolution of the estimated glomerular filtration rate (eGFR), analytical parameters, and blood pressure were analyzed.Results: A total of 163 patients (78.2%) received TV for 1 year. The main causes of treatment withdrawal were the aquaretic effects (11%), eGFR deterioration (5%), and hepatic toxicity (2.3%). eGFR decreased significantly after 1 month of treatment without further changes. The decrease in eGFR in the first month was higher in patients with an initially higher eGFR. The eGFR drop during the first year of treatment with TV was lower than that reported by patients in the 2 years prior to TV treatment (-1.7 +/- 7.6 vs. - 4.4 +/- 4.8 mL/min, p = 0.003). Serum sodium and uric acid concentrations increased, and morning urinary osmotatity decreased in the first month, with no further changes. Blood pressure decreased significantly without changes in antihypertensive medication.Conclusion: TV treatment is well tolerated by most patients. Liver toxicity is very rare and self-limited. TV reduces eGFR in the first month without showing further changes during the first year of treatment. Patients with a higher starting eGFR will suffer a greater initial drop, with a longer recovery. We suggest using the eGFR observed after a month of treatment as the reference for future comparisons and calculating the rate of eGFR decline in patients undergoing TV treatment.
PB FRONTIERS MEDIA SA
SN 2296-858X
YR 2022
FD 2022-09-29
LK http://hdl.handle.net/10498/29558
UL http://hdl.handle.net/10498/29558
LA eng
DS Repositorio Institucional de la Universidad de Cádiz
RD 08-nov-2026