This protocol addresses adults with autosomal dominant polycystic kidney disease (ADPKD) who have an eGFR ≥25 ml/min per 1.73 m² and evidence of rapid progression risk — identified by a Mayo Imaging Classification of class 1C, 1D, or 1E, or a documented historical eGFR decline rate of ≥3 ml/min per 1.73 m² per year.
In this population, management involves tolvaptan, initiated under a structured dose titration schedule with progressive escalation toward a defined target dose. The complete dosing sequence, titration intervals, and full clinical guidance are contained in the protocol below.
DOI: 10.1016/j.kint.2024.07.010
We recommend initiating tolvaptan treatment in adults with ADPKD with an estimated glomerular filtration rate (eGFR) ≥25 ml/min per 1.73 m2 who are at risk for rapidly progressive disease (Figure 25).
Tolvaptan should be initiated with a daily dose of 45 mg upon waking and 15 mg 8 hours later (Figure 28).
Uptitrating to a target daily dose of 90 mg upon waking and 30 mg 8 hours later should generally be the goal of therapy in all people with ADPKD unless this becomes intolerable or is contraindicated by drug interactions (Figure 28).