Urinary Lithogenic Risk Profile in ADPKD Patients Treated with Tolvaptan

Pietro Manuel Ferraro, Matteo Bargagli, Nasser A. Dhayat, Manuel Anderegg, Mariam Semmo, Uyen Huynh-Do, Bruno Vogt, Daniel G. Fuster

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background and objectives: Nephrolithiasis is a common health problem in autosomal dominant polycystic kidney disease (ADPKD) and significantly contributes to patient morbidity. Recently, Tolvaptan has been introduced for the treatment of ADPKD, but whether it is associated with alterations of the urinary lithogenic risk profile remains unknown. Design, setting, participants, & measurements: We conducted an analysis of participants enrolled in the Bern ADPKD registry, a prospective observational cohort study. Twenty-four-hour urine analyses were performed at baseline and then at yearly follow-ups. Relative supersaturation ratios for calcium oxalate, brushite, and uric acid were calculated with the program EQUIL2. Unadjusted and multivariable mixed-effects linear regression models, adjusted for age, sex, body mass index, eGFR, net acid excretion, and height-adjusted total kidney volume, were used to assess the association of Tolvaptan with urinary parameters relevant for kidney stone formation. The maximum individual follow-up time was 3 years, median follow-up time 1.9 years, and cumulative follow-up time 169 years. Results: In total, 125 participants (38 with and 87 without Tolvaptan treatment) were included in the analysis. In multivariable analysis, Tolvaptan treatment was associated [adjusted estimate of the difference between Tolvaptan and no Tolvaptan; 95% confidence interval (CI)] with lower urine relative supersaturation ratios for calcium oxalate (-0.56; 95% CI, -0.82 to -0.3; P<0.001), brushite (-0.33; 95% CI, -0.54 to -0.11; P=0.004), and uric acid (-0.62; 95% CI, -0.88 to -0.37; P<0.001), and with higher urine citrate in mmol/mmol creatinine per day (0.25; 95% CI, 0.05 to 0.46; P=0.02) and calcium in mmol/mmol creatinine per day (0.31; 95% CI, 0.09 to 0.53; P=0.006) excretion. In addition, Tolvaptan treatment was associated with lower net acid excretion in mEq/mmol creatinine per day (-0.54; 95% CI, -0.90 to -0.17; P=0.004) and higher net gastrointestinal alkali absorption in mEq/mmol creatinine per day (0.57; 95% CI, 0.26 to 0.88; P<0.001). Conclusions: Tolvaptan treatment is associated with a significantly improved urinary lithogenic risk profile in patients with ADPKD.
Original languageEnglish
Pages (from-to)N/A-N/A
JournalCLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
DOIs
Publication statusPublished - 2020

Keywords

  • ADPKD
  • alkalies
  • autosomal dominant
  • body mass index
  • calcium oxalate
  • calcium phosphate
  • citric acid
  • cohort studies
  • creatinine
  • dibasic
  • dihydrate
  • follow-up studies
  • glomerular filtration rate
  • kidney calculi
  • kidney stones
  • linear models
  • polycystic kidney
  • prospective studies
  • tolvaptan
  • uric acid

Fingerprint

Dive into the research topics of 'Urinary Lithogenic Risk Profile in ADPKD Patients Treated with Tolvaptan'. Together they form a unique fingerprint.

Cite this