Short-term renal hemodynamic effects of tolvaptan in subjects with autosomal dominant polycystic kidney disease at various stages of chronic kidney disease

Wendy E. Boertien, Esther Meijer, Paul E. de Jong, Stephan J. L. Bakker, Frank S. Czerwiec, Joachim Struck, Dorothee Oberdhan, Susan E. Shoaf, Holly B. Krasa, Ron T. Gansevoort*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

47 Citations (Scopus)

Abstract

Vasopressin V2-receptor antagonists may delay disease progression in ADPKD. Trials with V2-receptor antagonists have been performed predominantly in patients with an estimated creatinine clearance of 60 ml/min or more. Here we determined renal hemodynamic effects of the V2-receptor antagonist tolvaptan in 27 patients with ADPKD at various stages of chronic kidney disease: group A: >60, group B: 30-60, and group C: <30 ml/min per 1.73 m(2). Measurements were performed before, after 3 weeks of tolvaptan (up titration to 90/30 mg/day, split dose), and 3 weeks after the last dose of tolvaptan. With tolvaptan, a minor, reversible decrease in GFR ((125)I-iothalamate clearance) was found that reached significance in groups A and B: -7.8 (interquartile range -13.7 to -1.3) and -4.3 (-9.7 to -0.9) ml/min per 1.73 m(2), respectively, but not in group C (GFR decrease -0.7 (-1.1 to 1.5) ml/min/1.73 m(2)). The percentage change in GFR, ERPF ((131)I-hippuran clearance), and filtration fraction with tolvaptan did not differ between the three study groups. No differences between the three study groups were found in other main efficacy variables, besides smaller increases in urine volume in group C during tolvaptan treatment. Tolvaptan was well tolerated, with only two patients withdrawing. Thus, doses of tolvaptan typically used in patients with ADPKD do not produce a difference in renal hemodynamic profile in chronic kidney disease stages 1 through 4, but minor GFR drops may be observed in individual patients.

Original languageEnglish
Pages (from-to)1278-1286
Number of pages9
JournalKidney International
Volume84
Issue number6
DOIs
Publication statusPublished - Dec-2013

Keywords

  • ADPKD
  • clinical trial
  • glomerular filtration rate
  • renal hemodynamics
  • tolerance
  • vasopressin
  • GLOMERULAR-FILTRATION-RATE
  • NONPEPTIDE AVP ANTAGONIST
  • V2 RECEPTOR ANTAGONIST
  • HEALTHY-SUBJECTS
  • SERUM CREATININE
  • VASOPRESSIN
  • CELLS
  • RATS
  • I-125-IOTHALAMATE
  • PHARMACOKINETICS

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