Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.


Going with the flow

A phase 3 clinical trial published in the New England Journal of Medicine (doi:10.1056/NEJMoa1205511) shows mixed results in the treatment of autosomal dominant polycystic kidney disease (ADPKD).

Credit: BSIP / Science Source

ADPKD is marked by renal fluid-filled cysts that eventually lead to kidney failure. Preclinical studies have suggested that the antidiuretic hormone vasopressin contributes to pathogenesis, and a previous 3-year open-label clinical trial showed that tolvaptan, a vasopressin receptor antagonist, reduces the rate of increase in kidney volume and the decline in glomerular filtration rate in 63 patients with ADPKD.

In the new study, Vincente E. Torres et al. report in a 3-year multicenter double-blind, placebo-controlled phase 3 clinical trial that tolvaptan had similar beneficial effects on 740 patients. But they also found that the tolvaptan-treated patients had more adverse events, such as increased thirst, increased urine production and hepatic injury. Overall approximately threefold more patients in the treated group discontinued the trial versus those in the placebo group.

Tolvaptan could eventually be approved to treat ADPKD, but clearly other treatment modalities are needed. Fortunately, basic research in this area has been proceeding well, and other targets are in the works.


Rights and permissions

Reprints and Permissions

About this article

Cite this article

Levinson, R. Going with the flow. Nat Med 18, 1753 (2012).

Download citation

  • Published:

  • Issue Date:

  • DOI:


Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing