Overview
Autosomal dominant polycystic kidney disease (ADPKD) is characterized by progressive formation of renal cysts which ultimately lead to a loss of renal function.
Tolvaptan (a V2R antagonist) is currently the only effective treatment for preserving renal function in ADPKD. However, side-effects such as polyuria limit its tolerability and thereby the therapeutic potential. This study will test whether co-administration with hydochlorothiazide can improve V2RA efficacy (slowing kidney function decline) and tolerability (quality of life) in ADPKD. Approximately 300 patients will be enrolled.
Description
Aims: The main objectives of the current study are to prospectively test whether HCT co-treatment can improve V2RA efficacy (slowing kidney function decline) and tolerability (quality of life) in PKD.
Study design: Investigator driven randomized placebo-controlled multicenter trial
Study population: 300 ADPKD patients of ≥18 years, with an eGFR of \> 25 mL/min/1.73m2, on stable treatment with the highest tolerated dose of V2RA
Intervention: Oral HCT 25 mg once daily or matching placebo for a total of 156 weeks. The randomization ratio will be 1:1.
Study visit schedule: study measurements will be performed during 12-weekly visits (which is routine care for V2RA treated patients), except for one additional study visit (or telephone call) 2 weeks after the start of treatment
Primary study outcome: Slope of kidney function decline (measured by eGFR)
Eligibility
Inclusion Criteria:
- ADPKD diagnosis (modified Ravine criteria)
- ≥18 years old
- eGFR \> 25 mL/min/1.73m2
- On stable treatment with the highest tolerated dose of V2RA for a minimum of 3 months
Exclusion Criteria:
- Known intolerance to hydrochlorothiazide
- Use of any diuretic
- Orthostatic hypotension complaints or blood pressure \<105/65mmHg during screening visit
- Uncontrolled hypertension (blood pressure \>160/100mmHg)
- Hypokalemia (\<3.5 mmol/L)
- History of active gout on maintenance preventive treatment for gout (allopurinol, desuric and/or colchicine), defined as ≥2 episodes during the last year
- History of skin cancer (basal cell, squamous cell and melanoma)
