{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T23:11:37Z","timestamp":1792883497111,"version":"4.5.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2016,5]]},"abstract":"\n Background and objectives<\/jats:title>\n The effect of mammalian target of rapamycin (mTOR) inhibitors has never been tested in patients with autosomal dominant polycystic kidney disease (ADPKD) and severe renal insufficiency.<\/jats:p>\n <\/jats:sec>\n \n Design, setting, participants, & measurements<\/jats:title>\n \n In this academic, prospective, randomized, open label, blinded end point, parallel group trial (ClinicalTrials.gov no. NCT01223755), 41 adults with ADPKD, CKD stage 3b or 4, and proteinuria \u22640.5 g\/24 h were randomized between September of 2010 and March of 2012 to sirolimus (3 mg\/d; serum target levels of 5\u201310 ng\/ml) added on to conventional therapy (\n n<\/jats:italic>\n =21) or conventional treatment alone (\n n<\/jats:italic>\n =20). Primary outcome was GFR (iohexol plasma clearance) change at 1 and 3 years versus baseline.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n At the 1-year preplanned interim analysis, GFR fell from 26.7\u00b15.8 to 21.3\u00b16.3 ml\/min per 1.73 m\n 2<\/jats:sup>\n (\n P<\/jats:italic>\n <0.001) and from 29.6\u00b15.6 to 24.9\u00b16.2 ml\/min per 1.73 m\n 2<\/jats:sup>\n (\n P<\/jats:italic>\n <0.001) in the sirolimus and conventional treatment groups, respectively. Albuminuria (73.8\u00b181.8 versus 154.9\u00b1152.9\n \u03bc<\/jats:italic>\n g\/min;\n P<\/jats:italic>\n =0.02) and proteinuria (0.3\u00b10.2 versus 06\u00b10.4 g\/24 h;\n P<\/jats:italic>\n <0.01) increased with sirolimus. Seven patients on sirolimus versus one control had\n de novo<\/jats:italic>\n proteinuria (\n P<\/jats:italic>\n =0.04), ten versus three patients doubled proteinuria (\n P<\/jats:italic>\n =0.02), 18 versus 11 patients had peripheral edema (\n P<\/jats:italic>\n =0.04), and 14 versus six patients had upper respiratory tract infections (\n P<\/jats:italic>\n =0.03). Three patients on sirolimus had angioedema, 14 patients had aphthous stomatitis, and seven patients had acne (\n P<\/jats:italic>\n <0.01 for both versus controls). Two patients progressed to ESRD, and two patients withdrew because of worsening of proteinuria. These events were not observed in controls. Thus, the independent data and safety monitoring board recommend early trial termination for safety reasons. At 1 year, total kidney volume (assessed by contrast\u2013enhanced computed tomography imaging) increased by 9.0% from 2857.7\u00b11447.3 to 3094.6\u00b11519.5 ml on sirolimus and 4.3% from 3123.4\u00b11695.3 to 3222.6\u00b11651.4 ml on conventional therapy (\n P<\/jats:italic>\n =0.12). On follow-up, 37% and 7% of serum sirolimus levels fell below or exceeded the therapeutic range, respectively.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Finding that sirolimus was unsafe and ineffective in patients with ADPKD and renal insufficiency suggests that mTOR inhibitor therapy may be contraindicated in this context.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.09900915","type":"journal-article","created":{"date-parts":[[2016,2,22]],"date-time":"2016-02-22T22:34:06Z","timestamp":1456180446000},"page":"785-794","source":"Crossref","is-referenced-by-count":41,"title":["Effect of Sirolimus on Disease Progression in Patients with Autosomal Dominant Polycystic Kidney Disease and CKD Stages 3b-4"],"prefix":"10.2215","volume":"11","author":[{"given":"Piero","family":"Ruggenenti","sequence":"first","affiliation":[{"name":"Clinical Research Center for Rare Diseases \u201cAldo e Cele Dacc\u00f2,\u201d IRCCS\u2014Istituto di Ricerche Farmacologiche \u201cMario Negri,\u201d Bergamo, Italy;"},{"name":"Nephrology and Dialysis,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Gentile","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Rare Diseases \u201cAldo e Cele Dacc\u00f2,\u201d IRCCS\u2014Istituto di Ricerche Farmacologiche \u201cMario Negri,\u201d Bergamo, Italy;"},{"name":"Nephrology and Dialysis,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norberto","family":"Perico","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Rare Diseases \u201cAldo e Cele Dacc\u00f2,\u201d IRCCS\u2014Istituto di Ricerche Farmacologiche \u201cMario Negri,\u201d Bergamo, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Perna","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Rare Diseases \u201cAldo e Cele Dacc\u00f2,\u201d IRCCS\u2014Istituto di Ricerche Farmacologiche \u201cMario Negri,\u201d Bergamo, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Barcella","sequence":"additional","affiliation":[{"name":"Immunohematology and Transfusion Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matias","family":"Trillini","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Rare Diseases \u201cAldo e Cele Dacc\u00f2,\u201d IRCCS\u2014Istituto di Ricerche Farmacologiche \u201cMario Negri,\u201d Bergamo, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Cortinovis","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Rare Diseases \u201cAldo e Cele Dacc\u00f2,\u201d IRCCS\u2014Istituto di Ricerche Farmacologiche \u201cMario Negri,\u201d Bergamo, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Patricia","family":"Ferrer Siles","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Rare Diseases \u201cAldo e Cele Dacc\u00f2,\u201d IRCCS\u2014Istituto di Ricerche Farmacologiche \u201cMario Negri,\u201d Bergamo, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge Arturo","family":"Reyes Loaeza","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Rare Diseases \u201cAldo e Cele Dacc\u00f2,\u201d IRCCS\u2014Istituto di Ricerche Farmacologiche \u201cMario Negri,\u201d Bergamo, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Carolina","family":"Aparicio","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Rare Diseases \u201cAldo e Cele Dacc\u00f2,\u201d IRCCS\u2014Istituto di Ricerche Farmacologiche \u201cMario Negri,\u201d Bergamo, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Fasolini","sequence":"additional","affiliation":[{"name":"Radiology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio","family":"Gaspari","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Rare Diseases \u201cAldo e Cele Dacc\u00f2,\u201d IRCCS\u2014Istituto di Ricerche Farmacologiche \u201cMario Negri,\u201d Bergamo, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Martinetti","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Rare Diseases \u201cAldo e Cele Dacc\u00f2,\u201d IRCCS\u2014Istituto di Ricerche Farmacologiche \u201cMario Negri,\u201d Bergamo, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiola","family":"Carrara","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Rare Diseases \u201cAldo e Cele Dacc\u00f2,\u201d IRCCS\u2014Istituto di Ricerche Farmacologiche \u201cMario Negri,\u201d Bergamo, 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Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanishka","family":"Sharma","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Rare Diseases \u201cAldo e Cele Dacc\u00f2,\u201d IRCCS\u2014Istituto di Ricerche Farmacologiche \u201cMario Negri,\u201d Bergamo, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Antiga","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Rare Diseases \u201cAldo e Cele Dacc\u00f2,\u201d IRCCS\u2014Istituto di Ricerche Farmacologiche \u201cMario Negri,\u201d Bergamo, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Remuzzi","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Rare Diseases \u201cAldo e Cele Dacc\u00f2,\u201d IRCCS\u2014Istituto di Ricerche Farmacologiche \u201cMario Negri,\u201d Bergamo, 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