American Journal of Clinical and Experimental Medicine

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Two Year Experience with Tolvaptan in Patients with Rapidly Progressing Polycystic Kidney Disease

Received: 19 November 2019    Accepted: 05 December 2019    Published: 09 June 2020
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Abstract

Background: Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder in which patients progress to end stage chronic kidney disease. Tolvaptan, vasopressin V2 receptor antagonist, has been postulated as an effective treatment to slow this progression. METHOD: All patients with ADPKD in whom treatment with tolvaptan was initiated were selected, with follow-up until 30 June 2019. The initial dose was 45/15 mg/day, with monthly titration at 60/30 mg and 90/30 mg. Monthly anthropometric, analytical and adverse effects were collected. RESULT: We present results from of 12 patients (mean age 39.8 +/- 7.3 years; 4 men and 8 women). 100% of the patients were selected to start tolvaptan because they had evidence of rapidly progressing disease, with a confirmed annual estimated filtration rate (eGFR) decline ≥5 mL/min/1.73m2 in 1 year, and/or ≥2.5 mL/min/1.73m2 per year over a period of 5 years. All patients had symptoms derived from aquaresis from the beginning of treatment. A decline in eGFR was observed in all patients after starting tolvaptan, dropping 38,8% from its baseline in one patient. In two patients the drug was temporarily discontinued due to hepatotoxicity, with subsequent recovery. Conclusion: Symptoms derived from aquaresis are very common and it is not known if they can limit the tolerability of the drug. An initial decline of the eGFR is observed during the follow-up. Close monitoring of liver function is important because of the potential hepatotoxicity of tolvaptan. More follow-up time is needed to asses the long-term efficacy and safety of tolvaptan.

DOI 10.11648/j.ajcem.20200803.12
Published in American Journal of Clinical and Experimental Medicine (Volume 8, Issue 3, May 2020)
Page(s) 35-41
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Autosomal Dominant Polycystic Kidney Disease, Adpkd, Tolvaptan, Hepatotoxicity, Aquaresis

References
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Author Information
  • Nephrology Department, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain

  • Nephrology Department, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain

  • Nephrology Department, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain

  • Nephrology Department, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain

  • Nephrology Department, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain

  • Nephrology Department, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain

  • Nephrology Department, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain

  • Nephrology Department, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain

  • Nephrology Department, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain

  • Nephrology Department, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain

Cite This Article
  • APA Style

    Covadonga López del Moral Cuesta, Gema Fernández Fresnedo, Luis Martín Penagos, Jaime Mazón Ruiz, Marina De Cos Gómez, et al. (2020). Two Year Experience with Tolvaptan in Patients with Rapidly Progressing Polycystic Kidney Disease. American Journal of Clinical and Experimental Medicine, 8(3), 35-41. https://doi.org/10.11648/j.ajcem.20200803.12

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    ACS Style

    Covadonga López del Moral Cuesta; Gema Fernández Fresnedo; Luis Martín Penagos; Jaime Mazón Ruiz; Marina De Cos Gómez, et al. Two Year Experience with Tolvaptan in Patients with Rapidly Progressing Polycystic Kidney Disease. Am. J. Clin. Exp. Med. 2020, 8(3), 35-41. doi: 10.11648/j.ajcem.20200803.12

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    AMA Style

    Covadonga López del Moral Cuesta, Gema Fernández Fresnedo, Luis Martín Penagos, Jaime Mazón Ruiz, Marina De Cos Gómez, et al. Two Year Experience with Tolvaptan in Patients with Rapidly Progressing Polycystic Kidney Disease. Am J Clin Exp Med. 2020;8(3):35-41. doi: 10.11648/j.ajcem.20200803.12

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  • @article{10.11648/j.ajcem.20200803.12,
      author = {Covadonga López del Moral Cuesta and Gema Fernández Fresnedo and Luis Martín Penagos and Jaime Mazón Ruiz and Marina De Cos Gómez and José Luis Pérez Canga and Mara Serrano Soto and Milagros Heras Vicario and Emilio Rodrigo Calabia and Juan Carlos Ruiz San Millán},
      title = {Two Year Experience with Tolvaptan in Patients with Rapidly Progressing Polycystic Kidney Disease},
      journal = {American Journal of Clinical and Experimental Medicine},
      volume = {8},
      number = {3},
      pages = {35-41},
      doi = {10.11648/j.ajcem.20200803.12},
      url = {https://doi.org/10.11648/j.ajcem.20200803.12},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajcem.20200803.12},
      abstract = {Background: Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder in which patients progress to end stage chronic kidney disease. Tolvaptan, vasopressin V2 receptor antagonist, has been postulated as an effective treatment to slow this progression. METHOD: All patients with ADPKD in whom treatment with tolvaptan was initiated were selected, with follow-up until 30 June 2019. The initial dose was 45/15 mg/day, with monthly titration at 60/30 mg and 90/30 mg. Monthly anthropometric, analytical and adverse effects were collected. RESULT: We present results from of 12 patients (mean age 39.8 +/- 7.3 years; 4 men and 8 women). 100% of the patients were selected to start tolvaptan because they had evidence of rapidly progressing disease, with a confirmed annual estimated filtration rate (eGFR) decline ≥5 mL/min/1.73m2 in 1 year, and/or ≥2.5 mL/min/1.73m2 per year over a period of 5 years. All patients had symptoms derived from aquaresis from the beginning of treatment. A decline in eGFR was observed in all patients after starting tolvaptan, dropping 38,8% from its baseline in one patient. In two patients the drug was temporarily discontinued due to hepatotoxicity, with subsequent recovery. Conclusion: Symptoms derived from aquaresis are very common and it is not known if they can limit the tolerability of the drug. An initial decline of the eGFR is observed during the follow-up. Close monitoring of liver function is important because of the potential hepatotoxicity of tolvaptan. More follow-up time is needed to asses the long-term efficacy and safety of tolvaptan.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Two Year Experience with Tolvaptan in Patients with Rapidly Progressing Polycystic Kidney Disease
    AU  - Covadonga López del Moral Cuesta
    AU  - Gema Fernández Fresnedo
    AU  - Luis Martín Penagos
    AU  - Jaime Mazón Ruiz
    AU  - Marina De Cos Gómez
    AU  - José Luis Pérez Canga
    AU  - Mara Serrano Soto
    AU  - Milagros Heras Vicario
    AU  - Emilio Rodrigo Calabia
    AU  - Juan Carlos Ruiz San Millán
    Y1  - 2020/06/09
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ajcem.20200803.12
    DO  - 10.11648/j.ajcem.20200803.12
    T2  - American Journal of Clinical and Experimental Medicine
    JF  - American Journal of Clinical and Experimental Medicine
    JO  - American Journal of Clinical and Experimental Medicine
    SP  - 35
    EP  - 41
    PB  - Science Publishing Group
    SN  - 2330-8133
    UR  - https://doi.org/10.11648/j.ajcem.20200803.12
    AB  - Background: Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder in which patients progress to end stage chronic kidney disease. Tolvaptan, vasopressin V2 receptor antagonist, has been postulated as an effective treatment to slow this progression. METHOD: All patients with ADPKD in whom treatment with tolvaptan was initiated were selected, with follow-up until 30 June 2019. The initial dose was 45/15 mg/day, with monthly titration at 60/30 mg and 90/30 mg. Monthly anthropometric, analytical and adverse effects were collected. RESULT: We present results from of 12 patients (mean age 39.8 +/- 7.3 years; 4 men and 8 women). 100% of the patients were selected to start tolvaptan because they had evidence of rapidly progressing disease, with a confirmed annual estimated filtration rate (eGFR) decline ≥5 mL/min/1.73m2 in 1 year, and/or ≥2.5 mL/min/1.73m2 per year over a period of 5 years. All patients had symptoms derived from aquaresis from the beginning of treatment. A decline in eGFR was observed in all patients after starting tolvaptan, dropping 38,8% from its baseline in one patient. In two patients the drug was temporarily discontinued due to hepatotoxicity, with subsequent recovery. Conclusion: Symptoms derived from aquaresis are very common and it is not known if they can limit the tolerability of the drug. An initial decline of the eGFR is observed during the follow-up. Close monitoring of liver function is important because of the potential hepatotoxicity of tolvaptan. More follow-up time is needed to asses the long-term efficacy and safety of tolvaptan.
    VL  - 8
    IS  - 3
    ER  - 

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