What does this research mean for the field?

Centralized, specialist-led care models enable more consistent implementation and prescribing of tolvaptan for autosomal dominant polycystic kidney disease compared to distributed or hybrid pathways. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To identify the organisational, individual, and contextual factors driving variation in tolvaptan implementation across UK kidney centres managing autosomal dominant polycystic kidney disease.

September 10, 2026Implementation Science CommunicationsOpen Access

Understanding variation between kidney centres in implementation of tolvaptan in the management of autosomal dominant polycystic kidney disease: a multiple case study

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Authors

MGMatthew GittusUniversity of Sheffield JFJames FotheringhamUniversity of Sheffield AOAlbert OngUniversity of Sheffield

Discussion

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Overview

Multiple case study shows that centralised specialist care standardises tolvaptan delivery in polycystic kidney disease, highlighting that pathway design dictates access to targeted therapy.

Key Points

To identify the organisational, individual, and contextual factors driving variation in tolvaptan implementation across UK kidney centres managing autosomal dominant polycystic kidney disease.
Conducted a multiple case study across three National Health Service kidney centres in the UK selected for divergent prescribing practices between December 2024 and September 2025.
Collected and analysed data from 12 healthcare professional interviews, 23 patient consultation observations, and 8 clinical documents using framework analysis mapped to the Consolidated Framework for Implementation Research (CFIR).
Prior trial involvement and professional networks enabled two centres to rapidly launch tolvaptan pathways without additional funding, unlike the trial-naive centre.
A centralised, specialist-led model allowed systematic eligibility assessments and prompt initiation, whereas distributed and hybrid models introduced application discrepancies, capacity bottlenecks, or off-guideline prescribing.
Active consultant nephrologist champions improved access to therapy, while less experienced teams and high patient volumes limited timely treatment.

Cite This Study

Gittus et al. (2026) studied this question.

synapsesocial.com/papers/6aa27b6f58559d80afc74afe https://doi.org/10.1186/s43058-026-01087-7

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September 10, 2026Implementation Science CommunicationsOpen Access

Understanding variation between kidney centres in implementation of tolvaptan in the management of autosomal dominant polycystic kidney disease: a multiple case study

View Full Paper

Ask AI

Bookmark

Authors

MGMatthew GittusUniversity of Sheffield JFJames FotheringhamUniversity of Sheffield AOAlbert OngUniversity of Sheffield

Discussion

Member takes

Overview

Multiple case study shows that centralised specialist care standardises tolvaptan delivery in polycystic kidney disease, highlighting that pathway design dictates access to targeted therapy.

Key Points

To identify the organisational, individual, and contextual factors driving variation in tolvaptan implementation across UK kidney centres managing autosomal dominant polycystic kidney disease.
Conducted a multiple case study across three National Health Service kidney centres in the UK selected for divergent prescribing practices between December 2024 and September 2025.
Collected and analysed data from 12 healthcare professional interviews, 23 patient consultation observations, and 8 clinical documents using framework analysis mapped to the Consolidated Framework for Implementation Research (CFIR).
Prior trial involvement and professional networks enabled two centres to rapidly launch tolvaptan pathways without additional funding, unlike the trial-naive centre.
A centralised, specialist-led model allowed systematic eligibility assessments and prompt initiation, whereas distributed and hybrid models introduced application discrepancies, capacity bottlenecks, or off-guideline prescribing.
Active consultant nephrologist champions improved access to therapy, while less experienced teams and high patient volumes limited timely treatment.

Cite This Study

Gittus et al. (2026) studied this question.

synapsesocial.com/papers/6aa27b6f58559d80afc74afe https://doi.org/10.1186/s43058-026-01087-7

View Full Paper

Ask AI

Bookmark