scholarly journals Tolvaptan for Primary Aldosteronism and Autosomal Dominant Polycystic Kidney Disease: A Case Report

2018 ◽  
Vol 8 (1) ◽  
pp. 62-69 ◽  
Author(s):  
Kyohei Kunizawa ◽  
Junichi Hoshino ◽  
Hiroki Mizuno ◽  
Tatsuya Suwabe ◽  
Keiichi Sumida ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Polycystic Kidney Disease ◽  
Muscle Weakness ◽  
Primary Aldosteronism ◽  
Autosomal Dominant ◽  
Japanese Woman ◽  
High Dose ◽  
Polycystic Kidney ◽  
Old Japanese ◽  
Autosomal Dominant Polycystic Kidney

A 59-year-old Japanese woman was admitted for evaluation of muscle weakness. Autosomal dominant polycystic kidney disease had been diagnosed at the age of 47 years, followed by primary aldosteronism at 53 years. At the age of 58, tolvaptan was started (60 mg/day) to treat her renal disease. After 8 months of tolvaptan therapy, hypokalemia-related muscle weakness became prominent, and hypertension became refractory. Finally, treatment with low-dose tolvaptan (30 mg/day) and high-dose spironolactone (100 mg/day) normalized serum potassium and the blood pressure. Tolvaptan can induce urinary excretion of potassium in patients with primary aldosteronism, and possible mechanisms are discussed.

scholarly journals Regional Variance of the Early Use of Tolvaptan for Autosomal Dominant Polycystic Kidney Disease

Kidney360 ◽  
2020 ◽  
Vol 1 (8) ◽  
pp. 740-745
Author(s):  
Reiko Inoue ◽  
Hiroshi Nishi ◽  
Daisuke Inoue ◽  
Kenjiro Honda ◽  
Masaomi Nangaku
Keyword(s):  
Kidney Disease ◽  
Population Density ◽  
Polycystic Kidney Disease ◽  
Autosomal Dominant ◽  
Open Data ◽  
National Database ◽  
High Dose ◽  
Polycystic Kidney ◽  
Autosomal Dominant Polycystic Kidney ◽  
Medical Economy

BackgroundThe development and prompt dissemination of the first drug against a particular disease can contribute to improvements in national health status and medical economy end points and are assumedly affected by socioeconomic factors that have yet to be analyzed. Tolvaptan, a vasopressin receptor 2 antagonist, was developed to treat hyponatremia, congestive heart failure, and cirrhosis ascites, although the approved indications may differ among countries. In Japan, high-dose tolvaptan tablets were approved as the first drug for autosomal dominant polycystic kidney disease (ADPKD) in 2014. This study aimed to better understand the factors that influence the total number of regional prescriptions of tolvaptan for ADPKD since its launch.MethodsThe National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data was used as a national claim-based database. In each of the 47 prefectures in Japan, the total prescribed number of 30 mg tolvaptan tablets between 2015 and 2017 was examined. The parameters explaining the prescription variation among regions were then examined by correlation analysis.ResultsPrescriptions for high-dose tolvaptan increased substantially 2 years after the drug’s approval; however, the increase differed by approximately 21-fold between regions. Population density was positively associated with prescribed 30 mg tolvaptan tablets per 1000 population in 2015 (r=0.47, P<0.001). In addition, the increase in prescribed number of tablets per 1000 population was correlated with population density in 2016–2017 (r=0.30, P=0.04).ConclusionsThis macro perspective analysis revealed an urban-rural inequity in prescriptions for the newly approved drug for ADPKD. Further studies are needed to elucidate the factors affecting the geographic variation.

scholarly journals Long-Term Effects of High-Dose Tolvaptan for Autosomal Dominant Polycystic Kidney Disease Patients

2020 ◽  
Vol 10 (1) ◽  
pp. 9-17
Author(s):  
Shinya Nakatani ◽  
Eiji Ishimura ◽  
Yuri Machiba ◽  
Kenta Fujimoto ◽  
Hideki Uedono ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Polycystic Kidney Disease ◽  
Kidney Function ◽  
Autosomal Dominant ◽  
High Dose ◽  
Kidney Volume ◽  
Polycystic Kidney ◽  
Total Kidney Volume ◽  
Autosomal Dominant Polycystic Kidney

Tolvaptan, a vasopressin V2 receptor antagonist, was initially approved in Japan for treatment of autosomal dominant polycystic kidney disease (ADPKD). Recently, a retrospective study showed that the effect of tolvaptan on kidney function could be sustained for a long period. However, the long-term efficacy and safety of high-dose tolvaptan (120 mg/day) in individual cases remain unknown. We report here 2 Japanese ADPKD patients (males, 36 and 29 years old) treated with tolvaptan (120 mg/day) for 9 years, during which time determinations of estimated glomerular filtration rate (eGFR) and total kidney volume (TKV) were performed. In these 2 patients, eGFR prior to therapy was 57.3 and 76.3 mL/min/1.73 m2, respectively, and 30.2 and 43.5 mL/min/1.73 m2, respectively, after 9 years of tolvaptan treatment, for a relatively constant annual decline of –3.01 and –3.64 mL/min/1.73 m2, respectively. As compared to the predicted (calculated) eGFR without tolvaptan treatment, eGFR actually measured was higher by 15.3 and 12.6 mL/min/1.73 m2, respectively, after the 9-year therapy period. In addition, the rate of TKV increase was gradual, 2.4 and 4.7%, respectively, per year during the initial 3-year period, to 6.5 and 12.5%, respectively, per year in the following 6-year period. During the 9 years of treatment, neither patient showed tolvaptan-related adverse events. Our findings suggest that long-term administration of tolvaptan at a high dose is both safe and effective to preserve kidney function, though a gradual increase in TKV was seen in both of the present cases, particularly during the later phase.

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