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Moriyama T, Nakayama Y, Soejima M, Yokota Y, Ota K, Ito S, Kodama G, Nakamura N, Kurokawa Y, Yano J, Ueda U, Takamiya Y, Kaida Y, Hazama T, Shibata R, Koda Y, Fukami K. Effect of tolvaptan on renal involvement in patients with autosomal dominant polycystic kidney disease according to different gene mutations. Clin Exp Nephrol 2020; 25:251-260. [PMID: 33141305 PMCID: PMC7925507 DOI: 10.1007/s10157-020-01988-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/15/2020] [Indexed: 10/31/2022]
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder caused by mutations in the polycystic kidney disease (PKD) gene. Although tolvaptan has benefits for renal involvement, the different effects depending on the gene mutation type are unknown. Thus, we explore the different effects of tolvaptan on the annual changes in total kidney volume (%TKV) and estimated glomerular filtration rate (eGFR) according to the gene mutation type in ADPKD patients. METHODS In total, 135 ADPKD patients were screened, and 22 patients taking tolvaptan for at least a year were retrospectively studied at the Kurume University Hospital. We examined the decline in renal function and %TKV by computed tomography and analyzed the gene mutation. Patients were classified into the following four groups according to gene mutation type: PKD1-truncated, PKD1-non-truncated, PKD2, and mutation not found. Patients were treated with tolvaptan, and the effects of tolvaptan were analyzed according to the gene mutation type. RESULTS Patients (age: 52.3 ± 11.2 years) were administered tolvaptan at a dose of 45 or 60 mg. No variation was observed in the annual changes in eGFR (%eGFR) (before: - 10.5% ± 13.9%, after: - 14.4% ± 8.1%, P = 0.139), whereas %TKV was significantly improved after the tolvaptan treatment (before: 14.9% ± 8.0%, after: - 5.4% ± 7.6%, P < 0.001). Unlike %eGFR, tolvaptan treatment significantly improved %TKV, regardless of the type of gene mutation. CONCLUSIONS A year treatment with tolvaptan significantly improved %TKV in patients with ADPKD, regardless of the gene mutation type.
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Affiliation(s)
- Tomofumi Moriyama
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume city, Fukuoka, Japan
| | - Yosuke Nakayama
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume city, Fukuoka, Japan
| | - Mikiko Soejima
- Department of Forensic Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Yunosuke Yokota
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume city, Fukuoka, Japan
| | - Kanji Ota
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume city, Fukuoka, Japan
| | - Sakuya Ito
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume city, Fukuoka, Japan
| | - Goh Kodama
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume city, Fukuoka, Japan
| | - Nao Nakamura
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume city, Fukuoka, Japan
| | - Yuka Kurokawa
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume city, Fukuoka, Japan
| | - Junko Yano
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume city, Fukuoka, Japan
| | - Utako Ueda
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume city, Fukuoka, Japan
| | - Yoshimi Takamiya
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume city, Fukuoka, Japan
| | - Yusuke Kaida
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume city, Fukuoka, Japan
| | - Takuma Hazama
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume city, Fukuoka, Japan
| | - Ryo Shibata
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume city, Fukuoka, Japan
| | - Yoshiro Koda
- Department of Forensic Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Kei Fukami
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume city, Fukuoka, Japan.
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