Prescription of Tolvaptan for Management of Patients With ADPKD

The leading genetic cause of end-stage kidney disease in adults is autosomal dominant polycystic kidney disease (ADPKD). In 2018, the US Food and Drug Administration approved the use of tolvaptan as first-line treatment for patients with ADPKD at risk of rapid disease progression.

In a poster published in conjunction with ASN Kidney Week 2024, Niloufar Ebrahimi, MD, and colleagues at the Loma Linda University Medical Center, California, presented results of a study designed to examine physician confidence and barriers to prescription of tolvaptan for the management of ADPKD. The poster was titled Evaluating Physician Confidence and Barriers in Prescribing Tolvaptan for ADPKD Management.

The study utilized an online survey that assessed physician background, experience in managing ADPKD, familiarity with and use of tolvaptan, confidence in prescribing, barriers to prescribing, and the need for physician support and education. The survey was distributed via LinkedIn and X and received 110 responses. Of the physicians who responded to the survey, 108 had managed at least one patient with ADPKD in the past 5 years and met study criteria.

The Shapiro-Wilk test was used to test data normality. Frequency (percentage) and median (interquartile range) were used to describe categorical and continuous variables. Chi-square tests, t-tests, or Mann-Whitney tests were used to analyze group differences. Statistical analyses were conducted in RStudio.

Most of the respondents were male (80.6%). Median years in practice was 12. In the past 5 years, the median number of ADPKD patients seen was 10. Tolvaptan was prescribed by 62.0% of the respondents. Those who prescribed tolvaptan were primarily nephrologists who managed significantly more ADPKD patients than nonprescribers (98.5% vs 80.45%; P<.001 and 15 vs 9; P=.001, respectively).

The level of familiarity with ADPKD was higher among physicians who prescribed tolvaptan compared to those who did not (62.7% vs 14.6%). The tolvaptan prescribers also had more confidence in initiating (46.3% vs 9.8%) and adjusting tolvaptan dose (46.3% vs 4.9%) that nonprescribers. Prescribers also were more comfortable monitoring liver adverse events (49.3% vs 7.3%) and managing side effects (47.8% vs 7.3%).

“Addressing barriers to tolvaptan prescription is an essential step toward optimizing patient care,” the authors said.

Source: Ebrahimi N, Vakhshoori M, Abdi Pour A, Norouzi S. Evaluating physician confidence and barriers in prescribing tolvaptan for ADPKD management. PUB277. Abstract of a poster published in conjunction with the American Society of Nephrology Kidney Week 2024; October 24-27, 2024; San Diego, California.