ABSTRACT
Introduction: Tolvaptan has been shown to reduce renal volume and delay disease progression in autosomal-dominant polycystic kidney disease (ADPKD). However, no biomarkers are currently available to guide dose adjustment. We aimed to explore the possibility of individualized tolvaptan dose adjustments based on cut-off values for urinary osmolality (OsmU). Methods: This prospective cohort study included patients with ADPKD, with rapid disease progression. Tolvaptan treatment was initiated at a dose of 45/15 mg and increased based on OsmU, with a limit set at 200 mOsm/kg. Primary renal events (25% decrease in estimated glomerular filtration rate [eGFR] during treatment), within-patient eGFR slope, and side effects were monitored during the 3-year follow-up. Results: Forty patients participated in the study. OsmU remained below 200 mOsm/kg throughout the study period, and most patients required the minimum tolvaptan dose (mean dose, 64 [±10] mg), with a low discontinuation rate (5%). The mean annual decline in eGFR was -3.05 (±2.41) ml/min per 1.73 m2 during tolvaptan treatment, compared to the period preceding treatment, corresponding to a reduction in eGFR decline of more than 50%. Primary renal events occurred in 20% of patients (mean time to onset, 31 months; 95% confidence interval [CI] = 28-34). Conclusion: Individualized tolvaptan dose adjustment based on OsmU in patients with ADPKD and rapid disease progression provided benefits in terms of reducing eGFR decline, compared with reference studies, and displayed lower dropout rates and fewer side effects. Further studies are required to confirm optimal strategies for the use of OsmU for tolvaptan dose adjustment in patients with ADPKD.
ABSTRACT
La monitorización ambulatoria de la presión arterial (MAPA) es una herramienta básica en el diagnóstico y tratamiento de la hipertensión arterial (HTA). La validez se basa en el número de mediciones realizadas y en su duración. Nuestro objetivo es estudiar en nuestra serie de MAPA de 48 h, si existe justificación para ampliar la duración de la MAPA a 48 h. Material y métodos: Análisis retrospectivo de una serie de casos formada por 81 pacientes con MAPA de 48 h durante un periodo de cinco años (2013 a 2018). Se analizan las diferencias entre el primer y segundo día. Resultados: Ochenta y un pacientes, 44 hombres, edad media 52 años (± 18). Mayor promedio de presión arterial (PA) en el primer día (132/77 mmHg vs. 130/76 mmHg, p ≤ 0,01) y también mayor proporción de pacientes con HTA el primer día (59 vs. 50%; p ≤ 0,05). Los pacientes con enfermedad renal crónica (ERC) (n = 33) presentaron PA sistólica (PAS) mayor en la segunda noche (p ≤ 0,05), un patrón circadiano de mayor riesgo en el segundo día (dipper 13,6 vs. 86,4%, nondipper 60,7 vs. 41,7% y riser 30,3 vs. 18,8%; p ≤ 0,05), más diabetes (39%, p ≤ 0,01) y más hipertrofia del ventrículo izquierdo (HVI) (74%, p ≤ 0,05). Conclusiones: La MAPA de 48 h podría determinar mejor los valores de PA y patrón circadiano que la de 24 h, en especial a los pacientes con ERC y diabetes, ambas patologías de elevado riesgo cardiovascular.(AU)
Ambulatory blood pressure monitoring (ABPM) is a basic tool in the diagnosis and treatment of hypertension (HT). Validity is based on the number of readings taken and their duration. Our aim was to study in our 48-hour ABPM series whether extending the duration of ABPM to 48 hours is justified. Material and methods: Retrospective analysis of a case series comprising 81 patients with 48-hour ABPM over a 5-year period (2013 to 2018). We analysed the differences between the first and second day. Results: Eighty-one patients, 44 men, mean age of 52 years (± 18). The mean blood pressure (BP) was higher on the first day (132/77 mmHg vs. 130/76 mmHg, p ≤ .01) and there was also a greater proportion of patients with HT on the first day (59 vs. 50%; p ≤ .05). The patients with chronic kidney disease (CKD) (n = 33) had higher systolic BP (SBP) on the second night (p ≤ .05), a circadian rhythm of higher risk on the second day (dipper 13.6 vs. 86.4%, non-dipper 60.7 vs. 41.7%, and riser 30.3 vs. 18.8%; p ≤ .05), more diabetes (39%, p ≤ .01) and more left ventricular hypertrophy (LVH) (74%, p ≤ .05). Conclusions: 48-hour ABPM could determine BP readings and circadian rhythm better than 24-hour ABPM, especially in patients with CKD and diabetes, both diseases carrying high cardiovascular risk.(AU)
Subject(s)
Humans , Adult , Middle Aged , Hypertension , Cardiovascular Diseases , Renal Insufficiency, Chronic , Blood Pressure Monitoring, Ambulatory , Arterial Pressure , Diabetic Angiopathies , Hypertrophy, Left VentricularABSTRACT
Ambulatory blood pressure monitoring (ABPM) is a basic tool in the diagnosis and treatment of hypertension (HT). Validity is based on the number of readings taken and their duration. Our aim was to study in our 48-hour ABPM series whether extending the duration of ABPM to 48 hours is justified. MATERIAL AND METHODS: Retrospective analysis of a case series comprising 81 patients with 48-hour ABPM over a 5-year period (2013 to 2018). We analysed the differences between the first and second day. RESULTS: Eighty-one patients, 44 men, mean age of 52 years (± 18). The mean blood pressure (BP) was higher on the first day (132/77 mmHg vs. 130/76 mmHg, p ≤ .01) and there was also a greater proportion of patients with HT on the first day (59 vs. 50%; p ≤ .05). The patients with chronic kidney disease (CKD) (n = 33) had higher systolic BP (SBP) on the second night (p ≤ .05), a circadian rhythm of higher risk on the second day (dipper 13.6 vs. 86.4%, non-dipper 60.7 vs. 41.7%, and riser 30.3 vs. 18.8%; p ≤ .05), more diabetes (39%, p ≤ .01) and more left ventricular hypertrophy (LVH) (74%, p ≤ .05). CONCLUSIONS: 48-hour ABPM could determine BP readings and circadian rhythm better than 24-hour ABPM, especially in patients with CKD and diabetes, both diseases carrying high cardiovascular risk.
