A Pilot Study Examining the Effects of Tolvaptan on Residual Renal Function in Peritoneal Dialysis for Diabetics

Abstract

♦ Background: For patients with end-stage renal disease (ESRD), peritoneal dialysis (PD) serves as a possible renal replacement therapy. However, most PD patients, particularly those with ESRD and diabetes mellitus, reportedly discontinue PD early, resulting in shorter survival periods and poorer prognosis because of overhydration. Recently, the vasopressin-2 receptor antagonist tolvaptan was approved for volume control in patients with heart failure. The present study aimed to identify the effects of tolvaptan in diabetic PD patients. ♦ Methods: In this pilot study, the tolvaptan group (n = 12) were treated with 15 mg/day of tolvaptan 2 weeks after PD initiation and were prospectively analyzed for 1 year, and patients in the control group (n = 12) did not receive tolvaptan and were retrospectively analyzed for 1 year. In addition to the biochemical tests, echocardiograms, serum atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels, peritoneal Kt/V, and creatinine clearance (CCr) were examined at baseline and at 6 and 12 months after PD initiation. ♦ Results: In the control group, the urine volume, renal Kt/V, and renal CCr levels consistently decreased; however, these parameters were stably maintained during the study period in the tolvaptan group. Atrial natriuretic peptide, CRP levels and the left ventricular mass index of the tolvaptantreated group were significantly lower than those in the control group, whereas total protein and albumin levels were significantly higher at 6 and 12 months in the tolvaptan group. There were no obvious adverse effects. ♦ Conclusions: These data suggest that tolvaptan may preserve residual renal function and improve volume control in PD patients with diabetes mellitus.

Effect of Tolvaptan in Patients with Chronic Kidney Disease Stage G5, and Impact of Concomitant Use of Thiazide Diuretics: A Retrospective Cohort Study

“…Serum albumin and UPCR did not affect the efficacy of TLV, contrary to previous results using furosemide [19]. The efficacy of TLV as a diuretic may be even higher given its success in patients undergoing peritoneal dialysis [29,30] and hemodialysis [31]. However, using thiazide diuretics with TLV attenuated TLV's diuretic effects of increasing UV and decreasing UOsm and BW.…”

Advances in Understanding and Management of Residual Renal Function in Patients with Chronic Kidney Disease

“…In a pilot study, a total of 24 patients after PD initiation were divided into two groups: those who received tolvaptan treatment and those who did not. As a result, the urine volume, renal Kt/V, and renal creatinine clearance levels were consistently decreased in the control group, whereas these parameters were maintained in the tolvaptan group at 6 and 12 months [132] .…”

Efficacy and safety of oral tolvaptan in patients undergoing hemodialysis: a Phase 2, double-blind, randomized, placebo-controlled trial

“…In addition, tolvaptan has recently become clinically available for the treatment of autosomal dominant polycystic kidney disease (ADPKD) in Japan, the European Union, the USA and other countries [ 11–13 ]. A pilot study revealed that tolvaptan increased urine volume in patients with kidney failure on peritoneal dialysis [ 14 ]; however, the efficacy of tolvaptan in HD patients remains to be investigated and it is not yet approved for use in kidney failure.…”