ホシノ　ジユンイチ   HOSHINO Jiyun'ichi   星野　純一    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
論文種別	原著
言語種別	英語
査読の有無	査読なし
表題	Kidney Function Trajectories with Tolvaptan in ADPKD Patients with CKD-G5.
掲載誌名	正式名：Kidney international reports 略　 称：Kidney Int Rep ISSNコード：24680249/24680249
掲載区分	国外
巻・号・頁	10(6),pp.1864-1873
著者・共著者	Akinari Sekine, Junichi Hoshino, Toshio Mochizuki, Shinya Nakatani, Saori Nishio, Tatsuya Suwabe, Hiroki Hayashi, Hirayasu Kai, Koichi Seta, Fumihiko Hattanda, Sumi Hidaka, Kazushige Hanaoka, Mahiro Kurashige, Hiroshi Kataoka, Kiyotaka Uchiyama, Keiji Shimazu, Eiji Ishikawa, Yosuke Shimada, Haruna Kawano, Ken Tsuchiya, Shigeo Horie, Ichiei Narita, Yoshitaka Isaka, Satoru Muto
担当区分	2nd著者
発行年月	2025/06
概要	INTRODUCTION:Improvement of estimated glomerular filtration rate (eGFR) slope has been established using tolvaptan in patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD). In Japan, the therapeutic dose of tolvaptan (60-120 mg/d) must be discontinued at chronic kidney disease stage G5 (CKD-G5), eGFR < 15 ml/min per 1.73 m2. However, low-dose tolvaptan (≤ 15 mg/d) can be continued in CKD-G5 patients with heart failure complicated by kidney failure.METHODS:This was a Japanese nation-wide, multicenter, retrospective observational study. Between May 2014 and September 2019, 110 patients with ADPKD developed CKD-G5 were included (data: previous 10 years). Participants were categorized into 3 groups: the tolvaptan continued group (received tolvaptan before CKD-G5 and reduced the dose to ≤ 15 mg at CKD-G5, N = 14), the tolvaptan discontinued group (received tolvaptan before CKD-G5 but discontinued at CKD-G5, N = 13), and the non-tolvaptan group (never received tolvaptan, N = 83).RESULTS:The eGFR slope remained stable before and during CKD-G5 in the non-tolvaptan group. In the tolvaptan discontinued group, the eGFR slope was accelerated from before (-3.3 [-4.3, -2.5] ml/min per 1.73 m2/yr) to during CKD-G5 (-5.3 [-6.7, -3.8]). However, in the tolvaptan continued group, the eGFR slope did not change from before (-3.9 [-5.4, -2.6]) to during CKD-G5 (-3.8 [-5.4, -3.4]). Compared with the tolvaptan continued group, the eGFR slope worsened significantly from before to during CKD-G5 in the tolvaptan discontinued group (P = .006).CONCLUSION:Continuation of low-dose tolvaptan may be effective in suppressing kidney function deterioration in ADPKD patients with CKD-G5. A clinical trial is needed to evaluate its efficacy and safety.
DOI	10.1016/j.ekir.2025.03.020
PMID	40630279