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Sim JJ, Shu YH, Bhandari SK, Chen Q, Harrison TN, Lee MY, Munis MA, Morrissette K, Sundar S, Pareja K, Nourbakhsh A, Willey CJ. Data driven approach to characterize rapid decline in autosomal dominant polycystic kidney disease. PLoS One 2024; 19:e0298484. [PMID: 38837988 DOI: 10.1371/journal.pone.0298484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a genetic kidney disease with high phenotypic variability. Furthering insights into patients' ADPKD progression could lead to earlier detection, management, and alter the course to end stage kidney disease (ESKD). We sought to identify patients with rapid decline (RD) in kidney function and to determine clinical factors associated with RD using a data-driven approach. A retrospective cohort study was performed among patients with incident ADPKD (1/1/2002-12/31/2018). Latent class mixed models were used to identify RD patients using differences in eGFR trajectories over time. Predictors of RD were selected based on agreements among feature selection methods, including logistic, regularized, and random forest modeling. The final model was built on the selected predictors and clinically relevant covariates. Among 1,744 patients with incident ADPKD, 125 (7%) were identified as RD. Feature selection included 42 clinical measurements for adaptation with multiple imputations; mean (SD) eGFR was 85.2 (47.3) and 72.9 (34.4) in the RD and non-RD groups, respectively. Multiple imputed datasets identified variables as important features to distinguish RD and non-RD groups with the final prediction model determined as a balance between area under the curve (AUC) and clinical relevance which included 6 predictors: age, sex, hypertension, cerebrovascular disease, hemoglobin, and proteinuria. Results showed 72%-sensitivity, 70%-specificity, 70%-accuracy, and 0.77-AUC in identifying RD. 5-year ESKD rates were 38% and 7% among RD and non-RD groups, respectively. Using real-world routine clinical data among patients with incident ADPKD, we observed that six variables highly predicted RD in kidney function.
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Affiliation(s)
- John J Sim
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, United States of America
- Departments of Health Systems and Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America
| | - Yu-Hsiang Shu
- Biostatistics and Programming Clinical Affairs, Inari Medical, Irvine, CA, United States of America
| | - Simran K Bhandari
- Department of Internal Medicine, Bellflower Medical Center, Bellflower, CA, United States of America
| | - Qiaoling Chen
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Teresa N Harrison
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Min Young Lee
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, United States of America
| | - Mercedes A Munis
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Kerresa Morrissette
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Shirin Sundar
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, United States of America
| | - Kristin Pareja
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, United States of America
| | - Ali Nourbakhsh
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, United States of America
| | - Cynthia J Willey
- College of Pharmacy, University of Rhode Island, Kingston, RI, United States of America
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Yamazaki M, Kawano H, Miyoshi M, Kimura T, Takahashi K, Muto S, Horie S. Long-Term Effects of Tolvaptan in Autosomal Dominant Polycystic Kidney Disease: Predictors of Treatment Response and Safety over 6 Years of Continuous Therapy. Int J Mol Sci 2024; 25:2088. [PMID: 38396765 PMCID: PMC10888637 DOI: 10.3390/ijms25042088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
Tolvaptan, an oral vasopressin V2 receptor antagonist, reduces renal volume expansion and loss of renal function in patients with autosomal dominant polycystic kidney disease (ADPKD). Data for predictive factors indicating patients more likely to benefit from long-term tolvaptan are lacking. Data were retrospectively collected from 55 patients on tolvaptan for 6 years. Changes in renal function, progression of renal dysfunction (estimated glomerular filtration rate [eGFR], 1-year change in eGFR [ΔeGFR/year]), and renal volume (total kidney volume [TKV], percentage 1-year change in TKV [ΔTKV%/year]) were evaluated at 3-years pre-tolvaptan, at baseline, and at 6 years. In 76.4% of patients, ΔeGFR/year improved at 6 years. The average 6-year ΔeGFR/year (range) minus baseline ΔeGFR/year: 3.024 (-8.77-20.58 mL/min/1.73 m2). The increase in TKV was reduced for the first 3 years. A higher BMI was associated with less of an improvement in ΔeGFR (p = 0.027), and family history was associated with more of an improvement in ΔeGFR (p = 0.044). Hypernatremia was generally mild; 3 patients had moderate-to-severe hyponatremia due to prolonged, excessive water intake in response to water diuresis-a side effect of tolvaptan. Family history of ADPKD and baseline BMI were contributing factors for ΔeGFR/year improvement on tolvaptan. Hyponatremia should be monitored with long-term tolvaptan administration.
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Affiliation(s)
- Mai Yamazaki
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (M.Y.)
| | - Haruna Kawano
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (M.Y.)
- Department of Advanced Informatics for Genetic Diseases, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan
| | - Miho Miyoshi
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (M.Y.)
| | - Tomoki Kimura
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (M.Y.)
| | - Keiji Takahashi
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (M.Y.)
| | - Satoru Muto
- Department of Advanced Informatics for Genetic Diseases, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan
- Department of Urology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
| | - Shigeo Horie
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (M.Y.)
- Department of Advanced Informatics for Genetic Diseases, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan
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Rao J, Peng T, Li N, Wang Y, Yan C, Wang K, Qiu F. Nephrotoxicity induced by natural compounds from herbal medicines - a challenge for clinical application. Crit Rev Toxicol 2022; 52:757-778. [PMID: 36815678 DOI: 10.1080/10408444.2023.2168178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Herbal medicines (HMs) have long been considered safe and effective without serious toxic and side effects. With the continuous use of HMs, more and more attention has been paid to adverse reactions and toxic events, especially the nephrotoxicity caused by natural compounds in HMs. The composition of HMs is complex and various, especially the mechanism of toxic components has been a difficult and hot topic. This review comprehensively summarizes the kidney toxicity characterization and mechanism of nephrotoxic natural compounds (organic acids, alkaloids, glycosides, terpenoids, phenylpropanoids, flavonoids, anthraquinones, cytotoxic proteins, and minerals) from different sources. Recommendations for the prevention and treatment of HMs-induced kidney injury were provided. In vitro and in vivo models for evaluating nephrotoxicity and the latest biomarkers are also included in this investigation. More broadly, this review may provide theoretical basis for safety evaluation and further comprehensive development and utilization of HMs in the future.
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Affiliation(s)
- Jinqiu Rao
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China.,State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China
| | - Ting Peng
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China.,State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China
| | - Na Li
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China.,State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China
| | - Yuan Wang
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China.,State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China
| | - Caiqin Yan
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China
| | - Kai Wang
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China
| | - Feng Qiu
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China.,State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China
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Naranjo J, Borrego F, Rocha JL, Salgueira M, Martín-Gomez MA, Orellana C, Morales A, Vallejo F, Hidalgo P, Rodríguez F, Garófano R, González I, Esteban R, Espinosa M. Real clinical experience after one year of treatment with tolvaptan in patients with autosomal dominant polycystic kidney disease. Front Med (Lausanne) 2022; 9:987092. [PMID: 36250074 PMCID: PMC9557750 DOI: 10.3389/fmed.2022.987092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTolvaptan (TV) is the first vasopressin-receptor antagonist approved for the treatment of autosomal dominant polycystic kidney disease (ADPKD). No publications report TV experience in real clinical practice during the first year of treatment.MethodsA prospective study of an initial cohort of 220 rapidly progressing patients treated with TV for 12 months. The tolerability of TV, the evolution of the estimated glomerular filtration rate (eGFR), analytical parameters, and blood pressure were analyzed.ResultsA total of 163 patients (78.2%) received TV for 1 year. The main causes of treatment withdrawal were the aquaretic effects (11%), eGFR deterioration (5%), and hepatic toxicity (2.3%). eGFR decreased significantly after 1 month of treatment without further changes. The decrease in eGFR in the first month was higher in patients with an initially higher eGFR. The eGFR drop during the first year of treatment with TV was lower than that reported by patients in the 2 years prior to TV treatment (–1.7 ± 7.6 vs. –4.4 ± 4.8 mL/min, p = 0.003). Serum sodium and uric acid concentrations increased, and morning urinary osmolality decreased in the first month, with no further changes. Blood pressure decreased significantly without changes in antihypertensive medication.ConclusionTV treatment is well tolerated by most patients. Liver toxicity is very rare and self-limited. TV reduces eGFR in the first month without showing further changes during the first year of treatment. Patients with a higher starting eGFR will suffer a greater initial drop, with a longer recovery. We suggest using the eGFR observed after a month of treatment as the reference for future comparisons and calculating the rate of eGFR decline in patients undergoing TV treatment.
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Affiliation(s)
- Javier Naranjo
- Department of Nephrology, Hospital Universitario Puerta del Mar, Cádiz, Spain
- *Correspondence: Javier Naranjo,
| | - Francisco Borrego
- Department of Nephrology, Complejo Hospitalario de Jaén, Jaén, Spain
| | - José Luis Rocha
- Department of Nephrology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Mercedes Salgueira
- Department of Nephrology, Hospital Universitario Virgen del Macarena, Seville, Spain
| | - Maria Adoración Martín-Gomez
- Grupo de Estudio de la Enfermedad Poliquística Autosómica Dominante (GEEPAD), Granada, Spain
- Department of Nephrology, Hospital de Poniente, El Ejido, Spain
| | - Cristhian Orellana
- Department of Nephrology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Ana Morales
- Department of Nephrology, Hospital Universitario San Cecilio, Granada, Spain
| | - Fernando Vallejo
- Department of Nephrology, Hospital Universitario Puerto Real, Puerto Real, Spain
| | - Pilar Hidalgo
- Department of Nephrology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Remedios Garófano
- Department of Nephrology, Hospital Universitario Torrecardenas, Almería, Spain
| | - Isabel González
- Department of Nephrology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Rafael Esteban
- Grupo de Estudio de la Enfermedad Poliquística Autosómica Dominante (GEEPAD), Granada, Spain
- Department of Nephrology, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Mario Espinosa
- Department of Nephrology, Hospital Universitario Reina Sofia, Córdoba, Spain
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