Do you stop tolvaptan below a certain eGFR in a patient with autosomal dominant polycystic kidney disease?

In general, the practical guidelines support continuing tolvaptan until dialysis or transplant (Chebib and Torres, PMID 33705818). There are situations where I will discontinue sooner, either due to apparent lack of benefit, due to precipitous, unexpectedly rapid decline or accelerated decline, or, more often, due to patient preference. In cases of unexpected rate of decline, other etiologies of AKI should be investigated. Stopping tolvaptan at this stage is unlikely to be possible in a limited ...