Recommendations for the use of tolvaptan in autosomal dominant polycystic kidney disease: A position statement on behalf of the ERA-EDTA Working Groups on Inherited Kidney Disorders and European Renal Best Practice

Ron T. Gansevoort, Mustafa Arici, Thomas Benzing, Henrik Birn, Giovambattista Capasso, Adrian Covic, Olivier Devuyst, Christiane Drechsler, Kai Uwe Eckardt, Francesco Emma, Bertrand Knebelmann, Yannick Le Meur, Ziad A. Massy, Albert C M Ong, Alberto Ortiz, Franz Schaefer, Roser Torra, Raymond Vanholder, Andrzej Więcek, Carmine ZoccaliWim Van Biesen

Research output: Contribution to journalArticlepeer-review

Abstract

Recently, the European Medicines Agency approved the use of the vasopressin V2 receptor antagonist tolvaptan to slow the progression of cyst development and renal insufficiency of autosomal dominant polycystic kidney disease (ADPKD) in adult patients with chronic kidney disease stages 1-3 at initiation of treatment with evidence of rapidly progressing disease. In this paper, on behalf of the ERA-EDTA Working Groups of Inherited Kidney Disorders and European Renal Best Practice, we aim to provide guidance for making the decision as to which ADPKD patients to treat with tolvaptan. The present position statement includes a series of recommendations resulting in a hierarchical decision algorithm that encompasses a sequence of risk-factor assessments in a descending order of reliability. By examining the best-validated markers first, we aim to identify ADPKD patients who have documented rapid disease progression or are likely to have rapid disease progression. We believe that this procedure offers the best opportunity to select patients who are most likely to benefit from tolvaptan, thus improving the benefit-to-risk ratio and cost-effectiveness of this treatment. It is important to emphasize that the decision to initiate treatment requires the consideration of many factors besides eligibility, such as contraindications, potential adverse events, as well as patient motivation and lifestyle factors, and requires shared decision-making with the patient.

Original languageEnglish
Pages (from-to)337-348
Number of pages12
JournalNephrology Dialysis Transplantation
Volume31
Issue number3
DOIs
Publication statusPublished - Mar 1 2016

Keywords

  • ADPKD
  • tolvaptan
  • vasopressin V2 receptor antagonist

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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