Abstract | BACKGROUND AND OBJECTIVES: 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.
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Authors | Matteo Bargagli, Nasser A Dhayat, Manuel Anderegg, Mariam Semmo, Uyen Huynh-Do, Bruno Vogt, Pietro Manuel Ferraro, Daniel G Fuster |
Journal | Clinical journal of the American Society of Nephrology : CJASN
(Clin J Am Soc Nephrol)
Vol. 15
Issue 7
Pg. 1007-1014
(07 01 2020)
ISSN: 1555-905X [Electronic] United States |
PMID | 32527945
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2020 by the American Society of Nephrology. |
Chemical References |
- Antidiuretic Hormone Receptor Antagonists
- Calcium Phosphates
- Tolvaptan
- Calcium Oxalate
- Uric Acid
- Citric Acid
- Creatinine
- calcium phosphate, dibasic, dihydrate
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Topics |
- Adult
- Antidiuretic Hormone Receptor Antagonists
(therapeutic use)
- Calcium Oxalate
(urine)
- Calcium Phosphates
(urine)
- Citric Acid
(urine)
- Creatinine
(urine)
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Nephrolithiasis
(etiology, urine)
- Polycystic Kidney, Autosomal Dominant
(complications, drug therapy, urine)
- Registries
- Risk Factors
- Tolvaptan
(therapeutic use)
- Uric Acid
(urine)
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