- Design
- Commentary on a randomised controlled trial (LIPS)
- Population
- Adults with autosomal dominant polycystic kidney disease
- Primary outcome
- Decline in measured GFR
- Effect
- No benefit on measured GFR; possible effect on eGFR slope
A Kidney International commentary discusses the Lanreotide In Polycystic kidney disease Study (LIPS), described as the last randomised evaluation of somatostatin analogues in autosomal dominant polycystic kidney disease.
Lanreotide did not slow decline in measured GFR, the trial's primary outcome, though it suggested an effect on creatinine-based eGFR slope. The commentators attribute the discrepancy to the different behaviour of the two measures and to statistical modelling, and conclude that the trial supports KDIGO's recommendation against prescribing somatostatin analogues solely to preserve kidney function in ADPKD.
For practice, this leaves tolvaptan as the disease-modifying option for rapidly progressive ADPKD, with blood pressure control, sodium restriction and high water intake as the foundation. Somatostatin analogues retain a place for symptomatic polycystic liver disease, a separate indication. The commentary is a secondary source; the trial itself carries the data.
- Do not start a somatostatin analogue in ADPKD solely to slow loss of kidney function.
- Assess risk of rapid progression using total kidney volume and genotype where available.
- Consider tolvaptan for patients at risk of rapid progression who meet criteria.
- Reserve somatostatin analogues for symptomatic polycystic liver disease.
Why it matters
It ends a long-running debate and keeps patients off an injection that does not protect the kidney.
Don't overread it
An eGFR slope signal against a negative measured GFR result is not evidence of benefit.
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