Abstract
Polycystic liver disease (PLD) is a common extrarenal complication of autosomal dominant polycystic kidney disease (ADPKD), which causes compression-related syndrome and ultimately leads to liver dysfunction. Tolvaptan, a V2 receptor antagonist, is widely used to protect kidney function in ADPKD but its effect on PLD remains unknown. An observational cohort study was conducted to evaluate tolvaptan's effect on patients with PLD due to ADPKD. After screening 902 patients, we found the 107 ADPKD patients with PLD who met the criteria of tolvaptan use in Japan. Among them, tolvaptan was prescribed for 62 patients (tolvaptan group), while the other was defined as the non-tolvaptan group. Compared with the non-tolvaptan group, the tolvaptan group had larger height-adjusted total kidney volume (median 994(range 450-4152) mL/m, 513 (405-1928) mL/m, p = 0.01), lower albumin level (mean 3.9±SD 0.4 g/dL, 4.3±0.4g/dL, p<0.01), and higher serum creatinine level (1.2±0.4 mg/dL, 0.9±0.2 mg/dL, p<0.01). Although the median change in annual growth rate of total liver volume (TLV) was not statistically different between the tolvaptan group (-0.8 (-15.9, 16.7) %/year) and the non-tolvaptan group (1.7 (-15.6-18.7) %/year)(p = 0.52), 20 (43.5%) patients in the tolvaptan group experienced a decrease in the growth rate of TLV (responders). A multivariable logistic regression model adjusting for related variables showed that older age (odds ratio 1.15 [95% CI 1.01-1.32]) and a higher growth rate of TLV in the non-tolvaptan period (odds 1.45 95% CI 1.10-1.90) were significantly associated with responders. In conclusion, the change in annual growth rate of TLV in ADPKD patients taking tolvaptan was not statistically different compared with that in ADPKD patients without taking tolvaptan. However, tolvaptan may have the potential to suppress the growth rate of TLV in some PLD patients due to ADPKD, especially in older patients or those that are rapid progressors of PLD. Several limitations were included in this study, therefore well-designed prospective studies were required to confirm the effect of tolvaptan on PLD.
Highlights
Polycystic liver disease (PLD) is a rare inherited disease characterized by the development of multiple cysts in the liver [1, 2]
Genetic analysis has revealed that various genes are related to PLD [3], more than ninety percent of older patients with autosomal dominant polycystic kidney disease (ADPKD) have hepatic cysts [4]
To investigate the prognostic factors associated with the suppressive effect of tolvaptan on the growth rate of total liver volume (TLV), the tolvaptan group was classified into responders and non-responders according to the adjusted change in growth rate after tolvaptan use
Summary
Polycystic liver disease (PLD) is a rare inherited disease characterized by the development of multiple cysts in the liver [1, 2]. Genetic analysis has revealed that various genes are related to PLD [3], more than ninety percent of older patients with autosomal dominant polycystic kidney disease (ADPKD) have hepatic cysts [4]. Previous studies have shown that the progression of PLD was faster in specific patients, especially in younger women, which suggested that estrogen was related to cyst growth [8, 9]. Current medical therapies for symptomatic PLD include surgical interventions or several drugs that reduce intracellular cyclic adenosine monophosphate (cAMP). Surgical interventions [10–12] can reduce the mass effects of PLD, these treatments have little impact on the progression of PLD, whereas somatostatin analogs (SAs) are approved for clinical use and have been proven to decrease the growth rate of PLD [9, 13–18]
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