title: A Pilot Study Examining the Effects of Tolvaptan on Residual Renal Function in Peritoneal Dialysis for Diabetics.
abstract: BACKGROUND
  For patients with end-stage renal disease (ESRD), peritoneal dialysis (PD) serves as a possible renal replacement therapy. However, most PD patients, particularly those with ESRD and diabetes mellitus, reportedly discontinue PD early, resulting in shorter survival periods and poorer prognosis because of overhydration. Recently, the vasopressin-2 receptor antagonist tolvaptan was approved for volume control in patients with heart failure. The present study aimed to identify the effects of tolvaptan in diabetic PD patients.
  
  
  METHODS
  In this pilot study, the tolvaptan group (n = 12) were treated with 15 mg/day of tolvaptan 2 weeks after PD initiation and were prospectively analyzed for 1 year, and patients in the control group (n = 12) did not receive tolvaptan and were retrospectively analyzed for 1 year. In addition to the biochemical tests, echocardiograms, serum atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels, peritoneal Kt/V, and creatinine clearance (CCr) were examined at baseline and at 6 and 12 months after PD initiation.
  
  
  RESULTS
  In the control group, the urine volume, renal Kt/V, and renal CCr levels consistently decreased; however, these parameters were stably maintained during the study period in the tolvaptan group. Atrial natriuretic peptide, CRP levels and the left ventricular mass index of the tolvaptan-treated group were significantly lower than those in the control group, whereas total protein and albumin levels were significantly higher at 6 and 12 months in the tolvaptan group. There were no obvious adverse effects.
  
  
  CONCLUSIONS
  These data suggest that tolvaptan may preserve residual renal function and improve volume control in PD patients with diabetes mellitus.
authors.affiliation: Department of Nephrology, Aichi Welfare Cooperative Agricultural Federation, Konan-Kosei Hospital, Konan-city, Aichi, Japan t-hiramatsu@konan.jaaikosei.or.jp.
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Hiramatsu
authors.affiliation: Department of Nephrology, Aichi Welfare Cooperative Agricultural Federation, Konan-Kosei Hospital, Konan-city, Aichi, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Hobo
authors.affiliation: Department of Nephrology, Aichi Welfare Cooperative Agricultural Federation, Konan-Kosei Hospital, Konan-city, Aichi, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Hayasaki
authors.affiliation: Baxter Ltd., Chuo-ku, Tokyo, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Kabu
authors.affiliation: Department of Nephrology, Aichi Welfare Cooperative Agricultural Federation, Konan-Kosei Hospital, Konan-city, Aichi, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Furuta
mesh_terms: D000368:Aged; D065092:Antidiuretic Hormone Receptor Antagonists / Q000627:therapeutic use*; D009320:Atrial Natriuretic Factor / Q000097:blood; D001552:Benzazepines / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010530:Peritoneal Dialysis; D010537:Peritoneum / Q000378:metabolism; D010865:Pilot Projects; D011446:Prospective Studies; D012189:Retrospective Studies; D000077602:Tolvaptan
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D020097:Natriuretic Peptide, Brain; D000077602:Tolvaptan; D009320:Atrial Natriuretic Factor; D003404:Creatinine
keywords: Kt/V; Peritoneal dialysis; creatinine clearance; end-stage renal disease; tolvaptan; ultrafiltration; urine volume; vasopressin receptor
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