Treating Polycystic Kidney Disease (PKD): The Ideal Candidate for Vasopressin Antagonists

One treatment option for polycystic kidney disease (PKD) is vasopressin 2 receptor (V2R) antagonists. Not everyone is the right fit for V2R antagonists. For those who are a good candidate, these medications may help slow the progression of PKD and slow the decline of kidney function.

How do V2R antagonists work to treat polycystic kidney disease?

Vasopressin is a hormone that your brain secretes. In people with PKD, this hormone tends to be at very high levels. The hormone may play a role in  promoting the formation of cysts in the kidneys. 

V2R antagonists help reduce the action of vasopressin. This helps prevent cyst growth, which helps slow the decline of kidney function. It may also help reduce the cyst volume in any existing cysts.

How do you know if you are a good fit for V2R antagonists?

V2R antagonists are generally for people at a higher risk of severe PKD progression. Your care team will assess your risk through various methods, which may include imaging of your kidneys. 

An MRI is one form of imaging that, among other assessments, can help determine the volume of your kidneys. The size of the kidneys can help predict the course of PKD. In general, the larger the kidneys, the steeper the decline of kidney function, according to Priya Deshpande, MD, Nephrologist at the Mount Sinai Hospital. 

“Patients who are projected to need dialysis by the age of their 60s [or earlier] may be a good [or] ideal candidate for these medications,” says Dr. Despande.

Who is not an ideal candidate for V2R antagonists?

V2R antagonists have a small risk of causing serious liver damage in some people. For this reason, some people may not be a good candidate for this medication.

Upon starting this treatment, your care team will regularly check your liver function with blood tests.

People who already have other liver conditions may need special consideration to weigh the risks and benefits of using V2R antagonists. This includes:

• Hepatitis B

• Hepatitis C

• Liver cancer

• Liver disease

• Cirrhosis

Your care team may do a thorough evaluation of your liver to decide if this medication is safe for you or not.

Talk to your healthcare provider to learn more about how V2R antagonists work, what the risks versus benefits are, and they’d be right for your PKD.

Why trust our experts?

Written by:

Lauren Smith, MA

Lauren Smith, MA, has worked in health journalism since 2017. Before joining GoodRx, she was the senior health editor and writer for HealthiNation.

Reviewed by:

Alexandra Schwarz, MD

Alexandra Schwarz, MD, is a board-eligible sleep medicine physician and a board-certified family medicine physician. She is a member of both the AASM and the ABFM.

Our editorial standards

Meet our experts