The safety and efficacy of tolvaptan in the treatment of patients with autosomal dominant polycystic kidney disease: A systematic review and meta-analysis

Li, Xuanwei; Li, Wenlai; Li, Yue; Dong, Chuanjiang; Zhu, Ping

doi:10.1016/j.nefro.2022.10.002

Cited by 2 publications

(1 citation statement)

References 34 publications

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“…Tolvaptan, a vasopressin V2 receptor antagonist, is the only approved drug that can effectively slow down kidney volume growth and preserve renal function in ADPKD patients (29,30) . This is remarkable, considering that all anti-proliferative treatments have failed to achieve the same results.…”

Section: Discussionmentioning

confidence: 99%

Not a cluster of grapes, but bananas: Cord-like three-dimensional structure of cysts in ADPKD supports tubular obstruction hypothesis

Han,

Yang,

Song

et al. 2024

Preprint

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We investigated the three-dimensional structure of the kidneys of mouse models of autosomal dominant polycystic kidney disease (ADPKD), a progressive genetic kidney disease and one of the leading causes of end-stage renal disease. We performed histological observations and transparentized the kidneys for three-dimensional imaging on rapid-onset and chronic-onset models. We found that the cysts had a cord-like structure resembling a cluster of bananas rather than a bunch of grapes, suggesting tubular obstruction as the initiating event. We also detected epithelial cell bridges within the renal tubules, which could be the cause of the obstruction. We compared the cell proliferation of kidney tissue at different developmental stages with wild type mice, and found no significant difference, indicating that there was no additional cell proliferation. Our findings support the obstruction hypothesis and challenge the proliferation hypothesis for ADPKD, and may provide new insights for finding potential treatments.

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Section: Discussionmentioning

confidence: 99%

Not a cluster of grapes, but bananas: Cord-like three-dimensional structure of cysts in ADPKD supports tubular obstruction hypothesis

Han,

Yang,

Song

et al. 2024

Preprint

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Measured and Estimated Glomerular Filtration Rate to Evaluate Rapid Progression and Changes over Time in Autosomal Polycystic Kidney Disease: Potential Impact on Therapeutic Decision-Making

Miquel-Rodríguez,

González-Toledo,

Pérez-Gómez

et al. 2024

IJMS

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Autosomal polycystic kidney disease (ADPKD) is the most common genetic form of kidney failure, reflecting unmet needs in management. Prescription of the only approved treatment (tolvaptan) is limited to persons with rapidly progressing ADPKD. Rapid progression may be diagnosed by assessing glomerular filtration rate (GFR) decline, usually estimated (eGFR) from equations based on serum creatinine (eGFRcr) or cystatin-C (eGFRcys). We have assessed the concordance between eGFR decline and identification of rapid progression (rapid eGFR loss), and measured GFR (mGFR) declines (rapid mGFR loss) using iohexol clearance in 140 adults with ADPKD with ≥3 mGFR and eGFRcr assessments, of which 97 also had eGFRcys assessments. The agreement between mGFR and eGFR decline was poor: mean concordance correlation coefficients (CCCs) between the method declines were low (0.661, range 0.628 to 0.713), and Bland and Altman limits of agreement between eGFR and mGFR declines were wide. CCC was lower for eGFRcys. From a practical point of view, creatinine-based formulas failed to detect rapid mGFR loss (−3 mL/min/y or faster) in around 37% of the cases. Moreover, formulas falsely indicated around 40% of the cases with moderate or stable decline as rapid progressors. The reliability of formulas in detecting real mGFR decline was lower in the non-rapid-progressors group with respect to that in rapid-progressor patients. The performance of eGFRcys and eGFRcr-cys equations was even worse. In conclusion, eGFR decline may misrepresent mGFR decline in ADPKD in a significant percentage of patients, potentially misclassifying them as progressors or non-progressors and impacting decisions of initiation of tolvaptan therapy.

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The safety and efficacy of tolvaptan in the treatment of patients with autosomal dominant polycystic kidney disease: A systematic review and meta-analysis

Cited by 2 publications

References 34 publications

Not a cluster of grapes, but bananas: Cord-like three-dimensional structure of cysts in ADPKD supports tubular obstruction hypothesis

Not a cluster of grapes, but bananas: Cord-like three-dimensional structure of cysts in ADPKD supports tubular obstruction hypothesis

Measured and Estimated Glomerular Filtration Rate to Evaluate Rapid Progression and Changes over Time in Autosomal Polycystic Kidney Disease: Potential Impact on Therapeutic Decision-Making

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