부산대학교 도서관

BACKGROUND: Polycystic kidney disease (PKD) is a genetic disease, characterized by the formation of cysts within the kidneys. Arginine vasopressin (AVP) antagonist, tolvaptan, blocking at the V2 receptor results in suppression of AVP-induced cyclic adenosine monophosphate production and diminished kidney cyst cell proliferation. In this study, we aimed to analyze the safety and tolerability of tolvaptan for the management of autosomal dominant polycystic kidney disease (ADPKD) in patients, as well as study its efficacy in renal protection. METHODS: Thirty-five patients diagnosed with ADPKD were assessed for eligibility and taken from a mono-center during the period from 2007 to 2022. Totally, 24 patients complete 1-year study, and we arbitrarily divided them into responder or non-responder group as determined by a decline in estimated glomerular filtration rate (eGFR) of more than 5.0 mL/min/1.73 m^2 according to the regulation of National Health Insurance reimbursement for the second year. RESULTS: All patients reported relevant aquaresis-related symptoms, 3 (12.5%) developed moderate liver dysfunction needed to adjust their optimal dose of tolvaptan, hyperuricemia improved from 7.5 ± 1.4 to 5.6 ± 1.0 mg/dL (P ＜ 0.001) due to the increasing prescription of febuxostat. Mean arterial blood pressure dropped from 107.8 ± 12.7 to 98.8 ± 7.8 mmHg (P ＜ 0.001), use of calcium channel blockade declined from 11 (45.8%) to 4 (16.7%) (P = 0.039) and episodes of urinary tract infection dropped from 13 (56.5%) to 0 (0%) (P ＜ 0.001) after use of tolvaptan. Most responders could improve their ΔeGFR (range: -3.83 to 13.4 mL/min/1.73 m^2), but non-responders seemed to more decline their ΔeGFR after use of tolvaptan (range: -5.09 to -13.6 mL/min/1.73 m^2). Interestingly, we found 4 out of 5 patients had image study for their height-adjusted total kidney volume (htTKV) with significantly their htTKV reduced after use of tolvaptan. CONCLUSIION: Our small study determined that treating ADPKD patients with tolvaptan could achieve a decline in htTKV, reduce eGFR decline, and preserve Cr levels and blood pressure control, while having limited tolerable adverse effects, treatable hyperuricemia and controllable minor liver dysfunction. Thus, we conclude that tolvaptan is a safe and efficient form of treatment for ADPKD patients diagnosed with chronic kidney disease stage 3.