Evaluating Physician Confidence and Barriers in Prescribing Tolvaptan for ADPKD Management

Background: Autosomal dominant polycystic kidney disease (ADPKD) is the leading genetic cause of end-stage kidney disease in adults. The FDA approved tolvaptan in 2018 as the first treatment for ADPKD patients at risk of rapid disease progression. This study evaluates physicians' confidence and identifies barriers to prescribing tolvaptan for ADPKD management. Methods: A survey assessed physicians' backgrounds, ADPKD management experience, familiarity with and use of tolvaptan, confidence in prescribing, barriers to prescribing, and needs for support and education. Distributed online via LinkedIn and X, the survey received 110 responses; 108 respondents who had managed at least one ADPKD patient in the past five years met the study's criteria. Data normality was tested with the Shapiro-Wilk test. Categorical and continuous variables were described using frequency (percentage) and median (IQR). Group differences were analyzed using chi-square, t-tests, or Mann-Whitney tests as appropriate. Statistical analyses were conducted in RStudio, with P-values < 0.05 considered significant. Results: Participants were predominantly male (80.6%) with a median of 12 (7-20) years in practice. The median number of ADPKD patients seen in the past five years was 10 (7.5-22.5). Of the respondents, 62.0% had prescribed tolvaptan. Prescribers were mainly nephrologists, handling significantly more ADPKD patients than non-prescribers (98.5% vs. 80.45%, P<0.001 and 15 [10-30] vs. 9 [5-18.75], P=0.001, respectively). Tolvaptan prescribers exhibited higher level of familiarity with ADPKD (62.7% vs. 14.6%), confidence in starting (46.3% vs. 9.8%), adjusting tolvaptan (46.3% vs. 4.9%), comfort in monitoring liver adverse events (49.3% vs. 7.3%), and managing side effects (47.8% vs. 7.3%) compared to non-prescribers (Figure 1). Conclusion: Addressing barriers to tolvaptan prescription is an essential step toward optimizing patient care.Comparison of tolvaptan prescribers vs. non-prescribers