SP110EFFECT OF TOLVAPTAN ON RENAL PLASMA FLOW AND GLOMERULAR FILTRATION IN POLYCYSTIC KIDNEY DISEASE

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INTRODUCTION AND AIMS: Polycystic kidney disease (ADPKD) is a common genetic disorder, characterized by the formation of cyst in the kidneys, causing gradual renal failure. Previous studies have shown that, reduced glomerular filtration rate (GFR) and renal plasma flow (RPF) play a role in the progression of renal disease in ADPKD. Tolvaptan is a vasopressin 2 antagonist, which seems to reduce the growth of total kidney volume and the decline in e-GFR in ADPKD. The mechanisms are not fully understood and could, at least partly, be due to changes in renal plasma flow (RPF). The purpose of this trial, was to investigate if tolvaptan increase renal plasma flow and subsequently glomerular filtration in 18 ADPKD subjects, in a randomized, cross-over, double-blind, placebo-controlled study. METHODS: ADPKD-patients (CKD 1-3) were investigated twice (min. 10 days apart) after acute treatment with either tolvaptan 60 mg or placebo. 2 hours after treatment, RPF was estimated by 99-mTc-DTPA renography. RESULTS: Our preliminary results show a posterior RPF mean difference of 2.03ml/min 95% CI [-66.10; 62.04] p-value 0.948 and posterior GFR mean difference of -0.91ml/min 95%CI [-5.83; 7.65] p-value 0.779 after tolvaptan intake. After tolvaptan intake, the brachial systolic blood pressures drooped with mean value of -2.81mmHg 95% CI [-5.11;-0.50], p-value 0. 017. After tolvaptan intake, the central systolic blood pressures dropped with mean value of 3.50mmHg 95% CI [-5.84;-1.16], p-value 0.004. There was a mean difference in the brachial diastolic blood pressure of -1.16mmHg 95% CI: [-2.85:0.54] p-value 0.180 and central diastolic blood pressure of -1.58 mmHg 95%CI [-3.39;0.23], p-value 0.086 after tolvaptan intake. CONCLUSIONS: Our preliminary results suggest that, tolvaptan does not have an effect on RPF. Our preliminary results suggesting that the effects of tolvaptan on the progression of ADPKD is not mediated by changes in renal hemodynamics.

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