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

• Published in: BMC nephrology 2018-07, Vol.19 (1), p.157-5, Article 157
• Main Authors: Kramers, Bart J, van Gastel, Maatje D A, Meijer, Esther, Gansevoort, Ron T
• Format: Article
• Language: English
• Subjects: ADPKD; Antidiuretic Hormone Receptor Antagonists - adverse effects; Case Report; Case reports; Complications and side effects; Diabetes; Diabetes insipidus; Diuretics; Dosage and administration; Drug dosages; Drug therapy; Electrolytes; Epidermal growth factor receptors; Glomerular Filtration Rate - drug effects; Glomerular Filtration Rate - physiology; Humans; Hydrochlorothiazide; Hypertension; Kidney diseases; Male; Middle Aged; Nephrology; Patients; Polycystic kidney; Polycystic kidney disease; Polyuria; Polyuria - chemically induced; Polyuria - diagnosis; Polyuria - drug therapy; Renal replacement therapy; Risk factors; Side effects; Sodium; Sodium Chloride Symporter Inhibitors - pharmacology; Sodium Chloride Symporter Inhibitors - therapeutic use; Thiazides; Tolvaptan; Tolvaptan - adverse effects; Treatment Outcome; Urination disorders; Urine; Vasopressin
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-018-0957-7

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. 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/1.73m per year, whereas after hydrochlorothiazide was initiated this was - 3.97 mL/minute/1.73m per year. 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.