Long-Term Outcomes of Longitudinal Efficacy Study With Tolvaptan in ADPKD
Eiji Higashihara, Kikuo Nutahara, Masayuki Itoh, Takatsugu Okegawa, Mistuhiro Tambo, Tsuyoshi Yamaguchi, Yu Nakamura, Satoru Taguchi, Shinya Kaname, Kenichi Yokoyama, Tatsuya Yoshioka, Hiroshi Fukuhara
Abstract
INTRODUCTION: The effects of long-term and uninterrupted tolvaptan treatment on autosomal dominant polycystic kidney disease (ADPKD) are unclear. Therefore, a more than 3-year continuous treatment study was performed. METHODS: . Among 179 patients, 118 patients consented to the study. RESULTS: = 0.6321). Furthermore, during the 5 treatment-years, eGFR remained significantly better in the group with a percent decrease in eHTKV-α from baseline to the first treatment-year ≥ the median (2.94%) than in the group with a decrease <2.94%. The free-water clearance was higher in males than in females irrespective of treatment. CONCLUSION: The TKV growth rate decreased in 4 years with tolvaptan in both sexes. The insignificant effects of tolvaptan on the eGFR slope in males were likely due to androgen stimulation of cystogenesis and analytical difficulty of longitudinal changes in nonlinear trajectories of eGFR. The larger decrease in eHTKV-α in the first year was related to a better renal prognosis. The vasopressin-mediated water reabsorption was activated more in females than males irrespective of tolvaptan administration.