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Hajeong Lee

End-stage kidney disease (ESKD), which requires kidney replacement therapy (KRT) or comprehensive conservative management, burdens patients, their families and caregivers, and the healthcare system. The selection of the type of KRT for individual patients is therefore decided based on not only each patient’s medical condition but also his or her family support, social and financial resources, and the healthcare resources he or she receives.

Most decisions regarding KRT have been based on physician- or healthcare system/stakeholder-centered determinations rather than “patient-centered” choices, and thus many patients with ESKD feel insufficiently involved in their treatment options. However, it is also important to

Yong Chul Kim and Hajeong Lee

Tolvaptan, an oral selective vasopressin V2 receptor antagonist, was approved by the US Food and Drug Administration (FDA) for the treatment of clinically significant hypervolemic or euvolemic hyponatremia and rapidly progressing autosomal dominant polycystic kidney disease (ADPKD). It antagonizes the effect of an arginine vasopressin (antidiuretic hormone), which has a key role in water and circulatory homeostasis in the collecting duct of the kidney. Tolvaptan leads to an increase in urine water excretion (aquaresis) that results in enhanced free-water clearance in states of relative vasopressin excess, increasing serum sodium concentrations. Additionally, tolvaptan induces a reduction in cyclic adenosine monophosphate (cAMP),