Aim and Objective: Autosomal dominant polycystic kidney disease (ADPKD) is the common chronic kidney disease leads to end-stage renal disease (ESRD).To prevent progression of kidney failure is the key target of therapy. Tolvaptan could slow kidney cyst growth had been proved availability effective. The aims of this analysis are to perform a systematic review estimating and evaluating the efficacy and safety of tolvaptan on patients with autosomal dominant polycystic kidney disease.
Materials and Methods: The randomized controlled trials about tolvaptan in ADPKD were identified in PubMed, Ovid, Web of Science and the Cochrane library electronic database. Kidney function changes, treatment efficiency and the incidence of adverse events between the tolvaptan and placebo groups were compared. Data were analyzed by RevMan software.
Results: Totally we extracted eight trials including 7 double blinded randomised controlled trials and 1 quasi RCTs involving 1,536 patients. We found significant differences between tolvaptan and the placebo group on annual rate of change in the total kidney volume TKV at any stages of CKD (MD = -3.32, 95%CI =-4.57, -2.07, I2 =70%) and the glomerular filtration rate( MD = 1.4, 95% CI = 0.83,1.97, I2 =0%). Subgroup analysis of patients in different CKD stages also showed the same conclusions. There were increasing volume on urine osmolality, and 24-hour urine on tolvaptan patients. Reduction of serious hypertension and kidney pain events on ADPKD were also found in tolvaptan. But tolvaptan increased the risk of adverse events (liver injure, thirst, pollakiuria, nocturia) on higher dose. Not evidence of significant risk of bias was reported.
Conclusions: Tolvaptan have a beneficial effect on ADPKD, but associated with an increase of adverse events on high dose when comparing with the placebo. Further RCTs studies on tolvaptan may be required to support this conclusion.