Real clinical experience after one year of treatment with tolvaptan in patients with autosomal dominant polycystic kidney disease
BackgroundTolvaptan (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.MethodsA prospective study of an initial cohort...
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| Format: | Article |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.987092/full |
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| author | Javier Naranjo Francisco Borrego José Luis Rocha Mercedes Salgueira Maria Adoración Martín-Gomez Maria Adoración Martín-Gomez Cristhian Orellana Ana Morales Fernando Vallejo Pilar Hidalgo Francisca Rodríguez Remedios Garófano Isabel González Rafael Esteban Rafael Esteban Rafael Esteban Mario Espinosa |
| author_facet | Javier Naranjo Francisco Borrego José Luis Rocha Mercedes Salgueira Maria Adoración Martín-Gomez Maria Adoración Martín-Gomez Cristhian Orellana Ana Morales Fernando Vallejo Pilar Hidalgo Francisca Rodríguez Remedios Garófano Isabel González Rafael Esteban Rafael Esteban Rafael Esteban Mario Espinosa |
| author_sort | Javier Naranjo |
| collection | DOAJ |
| description | BackgroundTolvaptan (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.MethodsA 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.ResultsA 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 osmolality decreased in the first month, with no further changes. Blood pressure decreased significantly without changes in antihypertensive medication.ConclusionTV 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. |
| first_indexed | 2024-04-12T18:09:31Z |
| format | Article |
| id | doaj.art-d05ba1f52546485cbf29ba449c183e8a |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-12T18:09:31Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-d05ba1f52546485cbf29ba449c183e8a2022-12-22T03:21:52ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-09-01910.3389/fmed.2022.987092987092Real clinical experience after one year of treatment with tolvaptan in patients with autosomal dominant polycystic kidney diseaseJavier Naranjo0Francisco Borrego1José Luis Rocha2Mercedes Salgueira3Maria Adoración Martín-Gomez4Maria Adoración Martín-Gomez5Cristhian Orellana6Ana Morales7Fernando Vallejo8Pilar Hidalgo9Francisca Rodríguez10Remedios Garófano11Isabel González12Rafael Esteban13Rafael Esteban14Rafael Esteban15Mario Espinosa16Department of Nephrology, Hospital Universitario Puerta del Mar, Cádiz, SpainDepartment of Nephrology, Complejo Hospitalario de Jaén, Jaén, SpainDepartment of Nephrology, Hospital Universitario Virgen del Rocío, Seville, SpainDepartment of Nephrology, Hospital Universitario Virgen del Macarena, Seville, SpainGrupo de Estudio de la Enfermedad Poliquística Autosómica Dominante (GEEPAD), Granada, SpainDepartment of Nephrology, Hospital de Poniente, El Ejido, SpainDepartment of Nephrology, Hospital Universitario Puerta del Mar, Cádiz, SpainDepartment of Nephrology, Hospital Universitario San Cecilio, Granada, SpainDepartment of Nephrology, Hospital Universitario Puerto Real, Puerto Real, SpainDepartment of Nephrology, Hospital Regional Universitario de Málaga, Málaga, Spain0Department of Nephrology, Hospital Costa del Sol, Marbella, Spain1Department of Nephrology, Hospital Universitario Torrecardenas, Almería, Spain2Department of Nephrology, Hospital Universitario Juan Ramón Jiménez, Huelva, SpainGrupo de Estudio de la Enfermedad Poliquística Autosómica Dominante (GEEPAD), Granada, Spain3Department of Nephrology, Hospital Universitario Virgen de las Nieves, Granada, Spain4Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain5Department of Nephrology, Hospital Universitario Reina Sofia, Córdoba, SpainBackgroundTolvaptan (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.MethodsA 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.ResultsA 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 osmolality decreased in the first month, with no further changes. Blood pressure decreased significantly without changes in antihypertensive medication.ConclusionTV 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.https://www.frontiersin.org/articles/10.3389/fmed.2022.987092/fullglomerular filtration rate (eGFR)hepatic toxicitypolycystic kidney disease (PKD)tolvaptanurinary osmolality |
| spellingShingle | Javier Naranjo Francisco Borrego José Luis Rocha Mercedes Salgueira Maria Adoración Martín-Gomez Maria Adoración Martín-Gomez Cristhian Orellana Ana Morales Fernando Vallejo Pilar Hidalgo Francisca Rodríguez Remedios Garófano Isabel González Rafael Esteban Rafael Esteban Rafael Esteban Mario Espinosa Real clinical experience after one year of treatment with tolvaptan in patients with autosomal dominant polycystic kidney disease Frontiers in Medicine glomerular filtration rate (eGFR) hepatic toxicity polycystic kidney disease (PKD) tolvaptan urinary osmolality |
| title | Real clinical experience after one year of treatment with tolvaptan in patients with autosomal dominant polycystic kidney disease |
| title_full | Real clinical experience after one year of treatment with tolvaptan in patients with autosomal dominant polycystic kidney disease |
| title_fullStr | Real clinical experience after one year of treatment with tolvaptan in patients with autosomal dominant polycystic kidney disease |
| title_full_unstemmed | Real clinical experience after one year of treatment with tolvaptan in patients with autosomal dominant polycystic kidney disease |
| title_short | Real clinical experience after one year of treatment with tolvaptan in patients with autosomal dominant polycystic kidney disease |
| title_sort | real clinical experience after one year of treatment with tolvaptan in patients with autosomal dominant polycystic kidney disease |
| topic | glomerular filtration rate (eGFR) hepatic toxicity polycystic kidney disease (PKD) tolvaptan urinary osmolality |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.987092/full |
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