China: Tolvaptan and ADPKD

A recent meta-analysis published in Nefrologia journal has suggested that Tolvaptan, a medication used to delay the progression of autosomal dominant polycystic kidney disease (ADPKD) to end-stage renal disease (ESRD), may improve clinical progression in ADPKD patients without significantly increasing the risk of adverse reactions.

ADPKD is a genetic disorder characterized by the development of cysts in the kidneys, leading to kidney enlargement, kidney failure, and sometimes even liver and pancreatic cysts. The disease affects around 1 in 1000 people worldwide and is the fourth leading cause of kidney failure.

Two independent reviewers carried out the study, which involved the analysis of data from eight randomized controlled trials encompassing 2135 patients. The reviewers searched for relevant studies in several databases, including PubMed, EMBASE, Web of Science, and Cochrane, and extracted data, evaluated the risk of bias, and assessed the quality of evidence.

Key Clinical Findings

• Tolvaptan delayed the decline of estimated glomerular filtration rate (eGFR) and total kidney volume (TKV) in ADPKD patients when compared to the placebo group.
• The use of tolvaptan delayed TKV progression in different-month subgroups.
• Tolvaptan reduced renal pain and hematuria events in ADPKD patients.
• The prevalence of thirst and nocturia events was increased in the tolvaptan group compared to the placebo group.
• Tolvaptan reduced renal pain and hematuria events in ADPKD patients.

Tolvaptan is currently the only medication approved by the US Food and Drug Administration (FDA) to treat ADPKD, as it has been shown to slow the progression of the disease by reducing the growth of kidney cysts.

The researchers added that “The findings of this meta-analysis provide further evidence of the efficacy and safety of tolvaptan in the treatment of ADPKD, and may help to inform clinical decision-making regarding the use of this medication.”

Reference

Li, X., Li, W., Li, Y., Dong, C., & Zhu, P. (2023). The safety and efficacy of tolvaptan in the treatment of patients with autosomal dominant polycystic kidney disease: A systematic review and meta-analysis. Nefrologia. https://doi.org/10.1016/j.nefroe.2023.04.002