Kidney Week

Abstract: TH-PO445

Effectiveness of Tolvaptan on Kidney Replacement Therapy in Patients with Autosomal Dominant Polycystic Kidney Disease: A Retrospective Cohort Study from the TriNetX Global Collaborative Network

Session Information

• Cystic Kidney Diseases: Clinical Assessment and Therapeutic Directions
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Genetic Diseases of the Kidneys

• 1201 Genetic Diseases of the Kidneys: Cystic

Authors

• Wu, Ming-Ju, Taichung Veterans General Hospital, Taichung, Taiwan

Ming-Ju Wu, MD, DrMed, PhD

• Chen, Cheng-Hsu, Taichung Veterans General Hospital, Taichung, Taiwan

Cheng-Hsu Chen, MD, PhD

Background

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a major genetic contributor to end-stage kidney disease (ESKD). Current evidence on tolvaptan primarily focuses on slowing estimated glomerular filtration rate (eGFR) decline and kidney volume growth. However, direct confirmation of its effectiveness in reducing the need for hemodialysis in ESKD remains limited.

Methods

We enrolled ADPKD patients aged ≥18 years using TriNetx data from Sep 2, 2018, to Sep 3, 2023. Propensity score matching (PSM) ensured baseline comparability (standardized mean difference (SMD) <0.1).

Results

After 1:1 PSM, both groups comprised 673 patients. The average age was 45, with generally good health (3-5% diabetes, 2-3%). Baseline eGFR averaged ~50 ml/min/1.73m². Post-matching, all SMDs were <0.1, indicating successful matching. Tolvaptan users exhibited lower eGFR (47.3±26.5 vs. 53.5±34.3, p=0.001) and higher risk of stage 4-CKD (HR: 2.44, 95% CI:1.65, 3.60) compared to non-users. However, tolvaptan users showed significantly reduced chances of initiating hemodialysis (HR:0.362, 95%CI:0.18, 0.75), experiencing urinary tract infections (HR:0.58, 95%CI:0.35, 0.96), and all-cause mortality (HR:0.36, 95CI:0.18, 0.70). Lower eGFR in tolvaptan groups was not observed when refill time was ≥9. Kaplan-Meier curves for hemodialysis initiation indicated higher survival rates among tolvaptan users across age and refill time subgroups.

Conclusion

This real-world study, employing precise matching, reveals tolvaptan's role in reducing hemodialysis initiation risk in ADPKD, despite initial hemodynamic-induced lower eGFR. With more frequent refills, differences in subsequent eGFR became statistically insignificant.

Kaplan-Meier survival curves