Based on prior observations, researchers evaluated the associations of overweight and obesity with rapid progression of ADPKD in participants of the TEMPO 3:4 trial. While doing so, they also assess whether tolvaptan’s efficacy is attenuated in patients with baseline overweight or obesity. Fully adjust models indicated an association between higher BMI and greater annual percentage change in total kidney volume (TKV), with overweight and obesity associated with higher odds (ORs, 2.04 and 4.31, respectively) of annual percent change in TKV of 7% or greater, versus less than 5% for normal weight. However, eGFR decline did not differ by BMI.

“The three-way interaction (treatment×time×BMI group) was not statistically significant in linear mixed models with an outcome of TKV… or eGFR,” wrote the study authors. “Overweight and particularly obesity are strongly and independently associated with kidney growth, but not eGFR slope, in the TEMPO 3:4 trial, and tolvaptan efficacy is irrespective of BMI categorization.”