Yu Yan, Xiao-Min Li, Yan Yang, Feng-Mei Wang, Hong Liu, Ri-Ning Tang, Xiao-Liang Zhang, Bi-Cheng Liu, Bin Wang
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We further conducted immunohistochemical staining of renal biopsy tissues to investigate the roles of aquaporin-2 (AQP2) in the collecting duct and plasma albumin in predicting the efficacy of tolvaptan.</p><p><strong>Results: </strong>Of 174 CKD patients with volume overload, 108 (67.07%) were male. Group C and Group T each comprised 87 patients. At baseline, no significant differences in urine output and weight were noted. By day 3, Group T exhibited a greater increase in urine output (<i>P</i> < .001) and weight reduction (<i>P</i> < .001). At day 7, Group T maintained more significant diuretic effects (<i>P</i> < .001). More Group C patients required ultrafiltration therapy (<i>P</i> = .040). Adverse event rates did not significantly differ. 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引用次数: 0
摘要
研究目的这项回顾性研究评估了托伐普坦治疗慢性肾脏病（CKD）患者容量超负荷的疗效、安全性和预测指标：纳入2022年3月1日至2023年12月31日在东南大学附属中大医院接受襻利尿剂单独治疗或托伐普坦治疗的容量超负荷CKD患者。患者分为襻利尿剂组（C组）和襻利尿剂联合托伐普坦组（T组）。主要结果包括用药后一周内的血容量控制、体重变化、尿量和实验室指标。我们还记录了高钠血症和高钾血症等不良事件。我们还对肾活检组织进行了免疫组化染色，以研究集合管中的aquaporin-2（AQP2）和血浆白蛋白在预测托伐普坦疗效中的作用：在174例容量超载的慢性肾脏病患者中，108例（67.07%）为男性。C 组和 T 组各有 87 名患者。基线尿量和体重无明显差异。到第 3 天，T 组的尿量增加较多（P P P P = .040）。不良事件发生率无明显差异。值得注意的是，集合管中AQP2的表达可预测托伐普坦的反应性，而血浆白蛋白并不影响疗效：结论：托伐普坦在控制慢性肾脏病患者容量超负荷方面具有疗效和安全性。本研究方案经东南大学附属中大医院伦理委员会批准（批准号：2023ZDSYLL180-P01，临床试验注册号：ChiCTR2300075274，试验注册链接：https://www.chictr.org.cn/guide.html）。
Tolvaptan and the role of kidney aquaporin-2 abundance in managing volume overload in patients with CKD.
Objective: This retrospective study evaluated tolvaptan's efficacy, safety, and predictive indicators in managing volume overload in chronic kidney disease (CKD) patients.
Methods: CKD patients with volume overload, treated with loop diuretics alone or with tolvaptan at Zhongda Hospital, Southeast University, from 1 March 2022 to 31 December 2023, were included. Patients were divided into loop diuretic (Group C) and loop diuretic combined with tolvaptan (Group T) cohorts. Primary outcomes included volume control, changes in weight, urine output, and laboratory parameters within 1 week post-medication. Adverse events such as hypernatremia and hyperkalemia, etc., were recorded. We further conducted immunohistochemical staining of renal biopsy tissues to investigate the roles of aquaporin-2 (AQP2) in the collecting duct and plasma albumin in predicting the efficacy of tolvaptan.
Results: Of 174 CKD patients with volume overload, 108 (67.07%) were male. Group C and Group T each comprised 87 patients. At baseline, no significant differences in urine output and weight were noted. By day 3, Group T exhibited a greater increase in urine output (P < .001) and weight reduction (P < .001). At day 7, Group T maintained more significant diuretic effects (P < .001). More Group C patients required ultrafiltration therapy (P = .040). Adverse event rates did not significantly differ. Notably, AQP2 expression in the collecting duct may predict tolvaptan responsiveness, while plasma albumin did not affect efficacy.
Conclusion: Tolvaptan showed efficacy and safety in managing volume overload in CKD patients. The expression of AQP2 in the collecting duct could predict tolvaptan's efficacy.This study protocol was approved by the Ethics Committee of Zhongda Hospital Affiliated to Southeast University (Approval No. 2023ZDSYLL180-P01, Clinical Trial Registration No. ChiCTR2300075274, Trial Registration Link: https://www.chictr.org.cn/guide.html).
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About the Journal
Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.
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