Prescribing tolvaptan for autosomal dominant polycystic kidney disease within the general nephrology clinic setting

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Background

Tolvaptan is the first commercially available drug shown to improve rate of decline in renal function in patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD). Patients commencing tolvaptan require frequent follow-up and monitoring, which some units have approached with service redesign and initiation of specialist ADPKD clinics. Here we present the experience within our Trust of managing patients with ADPKD on tolvaptan within an undifferentiated general nephrology clinic.

Methods

Patients receiving tolvaptan for ADPKD were identified through our electronic record. Records were analysed to determine baseline demographics, maximum tolerated dose, biochemical monitoring and whether tolvaptan was discontinued.

Results

19 patients prescribed tolvaptan were identified at various stages of CKD 2 to 3b, with a median eGFR at commencement of tolvaptan of 43 mL/min/1.73m². All but three patients had renal function measurements up to 12 months post-commencement. 84% of patients achieved the maximum tolvaptan dose (90mg/30mg) – more than in the original tolvaptan trials. Of the intended 289 monitoring LFTs across the cohort, 279 tests were performed. Tolvaptan was discontinued in 2 patients. Changes in renal function were in keeping with the published literature.

Conclusion

Here we present a cohort of patients established on tolvaptan for ADPKD who were managed in an undifferentiated general nephrology clinic within a Trust that is one of the top ten users of tolvaptan in the UK. Our data suggests innovative treatments may be safely and effectively delivered within general nephrology clinics without necessarily requiring major service redesign.