Older patients with autosomal dominant PKD may benefit from tolvaptan treatment
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Key takeaways:
- Tolvaptan treatment correlated with a slowed annual rate of GFR decline in this population.
- Tolvaptan may correlate with improved kidney function.
Older patients with autosomal dominant polycystic kidney disease experienced a slowed annual rate of GFR decline by 1.66 mL/min/1.73 m2 per year when taking tolvaptan treatment, according to data published in Kidney Medicine.
“Tolvaptan is the only disease-specific treatment for [autosomal dominant PKD] ADPKD and is indicated to slow kidney function decline in patients who are at high risk of rapid progression,” Fouad T. Chebib, MD, from the division of nephrology and hypertension at Mayo Clinic in Florida, and colleagues wrote. They added, “Understanding potential benefits of tolvaptan use in patients with ADPKD aged [older than] 55 years and at later stages of [chronic kidney disease] CKD could help patients and their health care providers make informed treatment decisions.”
In a pooled analysis of eight studies that examined the impact of tolvaptan vs. non-tolvaptan standard of care, researchers measured the effect of the drug on eGFR decline among patients older than 55 years of age with advanced ADPKD. Data were derived from clinical studies sponsored by Otsuka or the NIH between 2005 and 2018.
A total of 230 patients used tolvaptan and 907 patients underwent the standard of care. A total of 95 patient pairs were matched in CKD G3.
Using mixed models with fixed effects for treatment, time, treatment-by-time interaction and baseline eGFR, researchers compared the effects of tolvaptan on annualized eGFR decline.
Analyses revealed a significant eGFR reduction of 1.66 mL/min/1.73 m2 in the tolvaptan group during a 3-year period, compared with the standard-of-care group. Researchers observed “significant improvements in the rate of kidney function decline among patients aged 56 to 65 years with low eGFR and rapid progression evidenced by a historical GFR rate of decline of [at least] 3 mL/min/1/73 m2 a year.”
Chebib and colleagues wrote, “While patients with more advanced CKD have less kidney function to preserve than patients who begin therapy at an earlier stage of their disease, the results of our analysis nonetheless suggest that tolvaptan treatment was associated with a significant benefit in older patients with advanced disease.”
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