Chapter 18 ADPKD

18.1 Blood pressure targets and RASi

HALT-PKD (early) (2014): with factorial design - standard (<130/80) vs. intensive (<110/75) ABP target and lisinopril plus telmisartan vs. lisinoprol plus placebo in ADPKD with eGFR >60. In the intensive blood pressure control group there was slower increase in kidney volume and a greater decline in LV mass index and albuminuria (but more hypotensive symptoms). There was no benefit of dual RAS blockade.

HALT-PKD (late) (2014): - lisinopril plus telmisartan vs. lisinopril plus placebo in ADPKD with eGFR 25–60. There was no benefit of dual RAS blockade (in time to death, ESRF or 50% reduction in eGFR).

18.2 Vasopressin antagonist therapy

TEMPO 3:4 (2012): - tolvaptan vs. placebo in ADPKD with TKV \(\geq\) 750 ml and CrCl \(\geq\) 60. Tolvaptan slowed rate of increase in kidney volume and decline in 1/Cr over 3 years; there were more adverse events in the tolvaptan group.

REPRISE (2017): - tolvaptan vs. placebo in ADPKD with eGFR 25–65 (or 25–44 if aged over 56). Tolvaptan slowed rate of decline in eGFR over 1 year; there were more elevations in ALT in the tolvaptan group.