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Effects of tolvaptan on renal function in chronic kidney disease patients with volume overload

Authors Suzuki S, Hanafusa N, Kubota K, Tsuchiya K, Nitta K

Received 8 March 2018

Accepted for publication 19 May 2018

Published 17 August 2018 Volume 2018:11 Pages 235—240


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Cristina Weinberg

Peer reviewer comments 4

Editor who approved publication: Professor Pravin Singhal

Shunji Suzuki,1,2 Norio Hanafusa,3 Kenji Kubota,1 Ken Tsuchiya,3 Kosaku Nitta2

1Department of Nephrology, Kawaguchi Saiseikai Hospital, Kawaguchi, Japan; 2Department of Medicine, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan; 3Department of Blood Purification, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan

Background: Fluid overload in chronic kidney disease (CKD) is generally controlled by diuretics, with potentially harmful effects on renal function. The efficacy of tolvaptan, a vasopressin V2-receptor antagonist and aquaretic, has not been evaluated for fluid control in CKD with reduced renal function.
Methods: Each patient from a group of 24 CKD patients on tolvaptan 15 mg/d plus conventional diuretics (T group) was matched by age and sex with a patient from a group of 24 CKD patients on conventional nonaquaretic diuretics alone not associated to tolvaptan other than tolvaptan (C group). Changes in renal function were compared between the groups for 1 year.
Results: There were no significant differences in blood pressure, hemoglobin levels, cardiac function, urine specific gravity, and urinary sodium concentration between the 2 groups at the beginning of the follow-up period and 1 year after. The estimated glomerular filtration rate (eGFR) by the formula developed by Japanese Society of Nephrology (in mL/min/1.73 m2) decreased: C group (from 28.3±13.6 to 23.0±12.3, p=0.09), T group (from 22.7±12.4 to 19.4±12.2, p=0.18), but both did not reach significance. A 50% reduction in eGFR was observed in 4 patients in the C group and 1 in the T group (p<0.05). A subgroup analysis performed on the patients with stage 3–4 CKD demonstrated a significant reduction in eGFR in the C group (n=17, p=0.04), but not in T group (n=17, p=0.07).
Conclusion: These results suggest that tolvaptan may have less effects on CKD progression among stage 3–4 CKD patients who are on conventional diuretics.

Keywords: tolvaptan, eGFR preservation, observational study, diuretics

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