Tolvaptan, a non-peptide arginine vasopressin V2 receptor antagonist, represents a breakthrough in the treatment of autosomal dominant polycystic kidney disease (ADPKD), aiming to reduce kidney volume and preserve kidney function. Since its approval for ADPKD treatment in December 2015, insurance coverage was granted in South Korea in 2019. Tolvaptan has demonstrated significant efficacy in preserving kidney function and reducing the total kidney volume (TKV) growth rate. However, aquaretic symptoms, inherent to the drug's mechanism, pose unavoidable side effects that can impact quality of life. Therefore, initiating tolvaptan necessitates a shared decision-making process to weigh its benefits against potential drawbacks. In this context, I aim to share my experiences with tolvaptan usage, emphasizing the importance of the shared decision-making approach.