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BMC Nephrology

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Open Access 01-12-2018 | Case report

Case report: a thiazide diuretic to treat polyuria induced by tolvaptan

Authors: Bart J. Kramers, Maatje D. A. van Gastel, Esther Meijer, Ron T. Gansevoort

Published in: BMC Nephrology | Issue 1/2018

Abstract

Background

Currently, the vasopressin V2 receptor antagonist tolvaptan is the only available treatment for autosomal dominant polycystic kidney disease (ADPKD), but there are tolerability issues due to aquaretic side-effects such as polyuria. A possible strategy to ameliorate these side-effects may be addition of a thiazide diuretic, this is an established treatment in nephrogenic diabetes insipidus, a condition where vasopressin V2 receptor function is absent.

Case presentation

We describe a 46-year-old male ADPKD-patient, who was prescribed tolvaptan, which caused polyuria of around 5 l per day. Hydrochlorothiazide was added to treat hypertension, which resulted in a marked decrease in urine production. While using tolvaptan, rate of eGFR decline was − 1.35 mL/min/1.73m² per year, whereas after hydrochlorothiazide was initiated this was − 3.97 mL/minute/1.73m² per year.

Conclusions

This case report indicates that while addition of hydrochlorothiazide may improve tolerability of vasopressin V2 receptor antagonists, co-prescription should only be used with great scrutiny as it may decrease tolvaptan effect on rate of ADPKD disease progression.

Grantham JJ. Clinical practice. Autosomal dominant polycystic kidney disease. N Engl J Med. 2008;359(14):1477–85.CrossRefPubMed

Willey CJ, Blais JD, Hall AK, Krasa HB, Makin AJ, Czerwiec FS. Prevalence of autosomal dominant polycystic kidney disease in the European Union. Nephrol Dial Transplant. 2016;32(8):1356–63.PubMedCentral

Spithoven EM, Kramer A, Meijer E, Orskov B, Wanner C, Caskey F, Collart F, Finne P, Fogarty DG, Groothoff JW, Hoitsma A, Nogier MB, Postorino M, Ravani P, Zurriaga O, Jager KJ, Gansevoort RT, ERA-EDTA Registry, EuroCYST Consortium, WGIKD, EuroCYST consortium, WGIKD. analysis of data from the ERA-EDTA registry indicates that conventional treatments for chronic kidney disease do not reduce the need for renal replacement therapy in autosomal dominant polycystic kidney disease. Kidney Int. 2014;86(6):1244–52.CrossRefPubMed

Torres VE, Chapman AB, Devuyst O, Gansevoort RT, Grantham JJ, Higashihara E, Perrone RD, Krasa HB, Ouyang J, Czerwiec FS, TEMPO 3:4 Trial Investigators. Tolvaptan in patients with autosomal dominant polycystic kidney disease. N Engl J Med. 2012;367(25):2407–18.CrossRefPubMedPubMedCentral

Torres VE, Chapman AB, Devuyst O, Gansevoort RT, Perrone RD, Koch G, Ouyang J, McQuade RD, Blais JD, Czerwiec FS, Sergeyeva O, REPRISE Trial Investigators. Tolvaptan in later-stage autosomal dominant polycystic kidney disease. N Engl J Med. 2017;377(20):1930–42.CrossRefPubMed

Boertien WE, Meijer E, de Jong PE, ter Horst GJ, Renken RJ, van der Jagt EJ, Kappert P, Ouyang J, Engels GE, van Oeveren W, Struck J, Czerwiec FS, Oberdhan D, Krasa HB, Gansevoort RT. Short-term effects of Tolvaptan in individuals with autosomal dominant polycystic kidney disease at various levels of kidney function. Am J Kidney Dis. 2015;65(6):833–41.CrossRefPubMed

Crawford JD, Kennedy GC, Hill LE. Clinical results of treatment of diabetes insipidus with drugs of the chlorothiazide series. N Engl J Med. 1960;262:737–43.CrossRefPubMed

Crawford JD, Kennedy GC. Chlorothiazid in diabetes insipidus. Nature. 1959;183(4665):891–2.CrossRefPubMed

Havard CW. Thiazide-induced antidiuresis in diabetes insipidus. Proc R Soc Med. 1965;58(12):1005–7.PubMedPubMedCentral

10.

Anonymous Jinarc : European public assessment reports – product information. London, 2016 (Accessed 3 Aug 2017, at http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002788/WC500187921.pdf). .

11.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, eggers P, van Lente F, Greene T, Coresh J. CKD-EPI (chronic kidney disease epidemiology collaboration): a new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12.CrossRefPubMedPubMedCentral

12.

Irazabal MV, Rangel LJ, Bergstralh EJ, Osborn SL, Harmon AJ, Sundsbak JL, Bae KT, Chapman AB, Grantham JJ, Mrug M, Hogan MC, El-Zoghby ZM, Harris PC, Erickson BJ, King BF, Torres VE, CRISP Investigators. Imaging classification of autosomal dominant polycystic kidney disease: a simple model for selecting patients for clinical trials. J Am Soc Nephrol. 2015;26(1):160–72.CrossRefPubMed

13.

Zittema D, van den Berg E, Meijer E, Boertien WE, Muller Kobold AC, Franssen CF, de Jong PE, Bakker SJ, Navis G, Gansevoort RT. Kidney function and plasma copeptin levels in healthy kidney donors and autosomal dominant polycystic kidney disease patients. Clin J Am Soc Nephrol. 2014;9(9):1553–62.CrossRefPubMedPubMedCentral

14.

Earley LE, Orloff J. The mechanism of Antidiuresis associated with the Administration of Hydrochlorothiazide to patients with vasopressin-resistant diabetes insipidus. J Clin Invest. 1962;41(11):1988–97.CrossRefPubMedPubMedCentral

15.

Bockenhauer D, Bichet DG. Pathophysiology, diagnosis and management of nephrogenic diabetes insipidus. Nat Rev Nephrol. 2015;11(10):576–88.CrossRefPubMed

16.

Fichman MP, Vorherr H, Kleeman CR, Telfer N. Diuretic-induced hyponatremia. Ann Intern Med. 1971;75(6):853–63.CrossRefPubMed

17.

Sonnenblick M, Friedlander Y, Rosin AJ. Diuretic-induced severe hyponatremia. Review and analysis of 129 reported patients. Chest. 1993;103(2):601–6.CrossRefPubMed

18.

Mann SJ. The silent epidemic of thiazide-induced hyponatremia. J Clin Hypertens (Greenwich). 2008;10(6):477–84.CrossRef

19.

Torres VE, Harris PC, Pirson Y. Autosomal dominant polycystic kidney disease. Lancet. 2007;369(9569):1287–301.CrossRefPubMed

20.

Ecder T, Edelstein CL, Fick-Brosnahan GM, Johnson AM, Chapman AB, Gabow PA, Schrier RW. Diuretics versus angiotensin-converting enzyme inhibitors in autosomal dominant polycystic kidney disease. Am J Nephrol. 2001;21(2):98–103.CrossRefPubMed

21.

Torres VE, Chapman AB, Devuyst O, Gansevoort RT, Perrone RD, Dandurand A, Ouyang J, Czerwiec FS, Blais JD, TEMPO 4:4 Trial Investigators. Multicenter, open-label, extension trial to evaluate the long-term efficacy and safety of early versus delayed treatment with tolvaptan in autosomal dominant polycystic kidney disease: the TEMPO 4:4 trial. Nephrol Dial Transplant. 2017;31:gfx043.

22.

Shoaf SE, Bramer SL, Bricmont P, Zimmer CA. Pharmacokinetic and pharmacodynamic interaction between tolvaptan, a non-peptide AVP antagonist, and furosemide or hydrochlorothiazide. J Cardiovasc Pharmacol. 2007;50(2):213–22.CrossRefPubMed

Title: Case report: a thiazide diuretic to treat polyuria induced by tolvaptan
Authors: Bart J. Kramers
Maatje D. A. van Gastel
Esther Meijer
Ron T. Gansevoort
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Nephrology / Issue 1/2018
Electronic ISSN: 1471-2369
DOI: https://doi.org/10.1186/s12882-018-0957-7

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