Reduction in Risk of Hemodialysis in Patients With ADPKD Treated With Tolvaptan

Patients with autosomal dominant polycystic kidney disease (ADPKD) face increased risk for end-stage renal disease. Previous studies have focused on the use of tolvaptan to slow decline in eGFR and growth in kidney volume. There are few data on the effectiveness of tolvaptan in reducing the need for hemodialysis among patients with ESRD.

During a poster session at ASN Kidney Week 2024, Ming-Ju Wu, MD, PhD, and Cheng-Hso Chen, MD, of the Taichung Veterans General Hospital, Taiwan, presented results of a recent retrospective cohort study on the use of tolvaptan in patients with ADPKD. The poster was titled Effectiveness of Tolvaptan on Kidney Replacement Therapy in Patients With Autosomal Dominant Polycystic Kidney Disease: A Retrospective Cohort Study from the TriNetX Global Collaborative Network.

Using data from the TriNetX network, 673 patients were enrolled in the study. Eligible patients were ≥18 years of age with ADPKD. Enrollment occurred from September 2, 2018, to September 3, 2023. Baseline comparability was determined using propensity score matching. Post-matching, all standard mean differences were <0.1, indicating successful matching.

The average age of the overall cohort was 45 years, with generally good health. Average eGFR was approximately 50 mL/min/1.73 m². Compared to those in the non-tolvaptan group, tolvaptan users had lower eGFR (47.3 mL/min/1.73 m² vs 53.5 mL/min/1.73 m²) and higher risk of stage 4 chronic kidney disease. The chances of initiating hemodialysis was significantly reduced among the tolvaptan users (hazard ratio [HR], 0.362; 95% CI, 0.18-0.75). The risks of experiencing urinary tract infections (HR, 0.58; 95% CI, 0.35-0.96) and all-cause mortality (HR, 0.36; 95% CI, 0.18-0.70) were also reduced in those in the tolvaptan groups.

When refill time was ≥9, lower eGFR was not observed in the tolvaptan group. Kaplan-Meier curves for initiation of hemodialysis among tolvaptan users revealed higher survival rates across age and refill time subgroups.

In conclusion, the authors said, “This real-world study, employing precise matching, reveals tolvaptan’s role in reducing hemodialysis initiation risk in ADPKD, despite initial hemodynamic-induced lower eGFR. With more frequent refills, differences in subsequent eGFR became statistically insignificant.”

Source: Wu M-J, Chen C-H. Effectiveness of tolvaptan on kidney replacement therapy in patients with autosomal dominant polycystic kidney disease: a retrospective cohort study from the TriNetX global collaborative network. TH-PO445. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2024; October 24, 2024; San Diego, California.