Virtual Nephrology Panel to Monitor Tolvaptan Use in Patients with ADPKD

Spring Clinical Meetings 2021

Tolvaptan has been approved by the FDA for use in patients with autosomal dominant polycystic kidney disease (ADPKD) to slow decline in glomerular filtration rate (GFR), increasing the therapeutic options for treatment of patients with the genetic kidney disease. Initiation of tolvaptan is time and resource intensive for patients and their healthcare providers. Kaiser Permanente Northern California (KPNC) established a virtual ADPKD nephrology panel to provide comprehensive care to patients with ADPKD.

During a virtual poster session at the NKF 2021 Spring Clinical Meetings, Lin Duong, PharmD described a model designed to leverage regional specialists to provide care for ADPKD patients spanning 15 service areas. The poster was titled Implementing a Virtual Nephrology Panel for Tolvaptan Use in Patients with ADPKD.

Beginning in 2019, a panel that included nephrologists and pharmacists met virtually every month to review consults for initiation of tolvaptan. The panel checked for complete work up, performed chart review, and screened candidacy criteria to establish recommendations. The patients were screened based on US expert guidelines.

Upon initiation of tolvaptan, the patients also meet virtually with the panel pharmacist who reviews and assists with risk evaluation and mitigation strategy, education, and monitoring of adverse effects and status reports. The pharmacist also works with local nephrologists to monitor for laboratory trends and dose changes. Electronic medical records provide updates to the panel. The panel also reviews complex issues such as extra-renal manifestations of ADPKD.

As of the publication of the poster, the panel had screened 34 cases. Nine of the patients initiated tolvaptan; three of those patients subsequently discontinued use. Doses were up-titrated as allowed by patient tolerance and laboratory results. Dose decreases or discontinuations were related to increases in sodium or glomerular filtration rate, liver function test, abdominal pain, or aquaretic side effects. To date, no major adverse effects have occurred. The monthly check-ins by the pharmacist in tandem with local nephrologists has ensured consistent education, care, and monitoring by the ADPKD panel.

In conclusion, the author said, “The virtual ADPKD panel provides specialized knowledge and ongoing carefully monitored care. The workflow can work for any KPNC service area and provides a seamless resource to local physicians and patients. Moreover, dedicated pharmacy support in the ADPKD panel augments patient care.”

Source: Duong L. Implementing a virtual nephrology panel for tolvaptan use in patients with ADPKD. Abstract of a poster presented at the National Kidney Foundation virtual Spring Clinical Meetings 2021 (Abstract #305), April 9, 2021.