title: Tolvaptan reduces the risk of worsening renal function in patients with acute decompensated heart failure in high-risk population.
abstract: BACKGROUND
  Although tolvaptan is a recently approved drug for heart failure and causes aquaresis without affecting renal function, its clinical efficacy for patients with acute decompensated heart failure (ADHF) is yet to be elucidated.
  
  
  RESULTS
  We conducted a prospective observational study in patients with ADHF and high risk for worsening renal function (WRF). Risk stratification for WRF was done by scoring system. Of 174 patients, 114 patients were included as high-risk population for WRF. Incidence of WRF, urine output within 24h and 48 h, and changes in brain natriuretic peptide (BNP) were recorded in 44 patients treated with tolvaptan plus conventional therapy, and 70 patients with only conventional therapy. Urine output at 24h and 48 h after admission were both significantly higher in the tolvaptan group (p=0.001 and <0.001, respectively), and changes in BNP were not significantly different (p=0.351). However, the incidence of WRF was significantly lower in the tolvaptan group compared to the conventional group (22.7% vs 41.4%, p=0.045). Logistic regression analysis showed that treatment with tolvaptan was an independent factor for reducing WRF (hazard ratio 0.28, 95% confidence interval; 0.10-0.84; p=0.023).
  
  
  CONCLUSIONS
  In patients with ADHF with high risk of WRF, treatment with tolvaptan could prevent WRF compared to conventional therapy.
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929 Higashi-chou, Kamogawa-City, Chiba 296-8602, Japan. yuya8950@gmail.com
authors.forename: Yuya
authors.initials: Y
authors.lastname: Matsue
authors.forename: Makoto
authors.initials: M
authors.lastname: Suzuki
authors.forename: Mie
authors.initials: M
authors.lastname: Seya
authors.forename: Ryota
authors.initials: R
authors.lastname: Iwatsuka
authors.forename: Akira
authors.initials: A
authors.lastname: Mizukami
authors.forename: Wataru
authors.initials: W
authors.lastname: Nagahori
authors.forename: Masakazu
authors.initials: M
authors.lastname: Ohno
authors.forename: Akihiko
authors.initials: A
authors.lastname: Matsumura
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hashimoto
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001552:Benzazepines / Q000627:therapeutic use*; D057186:Comparative Effectiveness Research; D003404:Creatinine / Q000097:blood / Q000652:urine; D004231:Diuresis / Q000187:drug effects*; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005665:Furosemide / Q000627:therapeutic use*; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D006955:Hypernatremia / Q000517:prevention & control; D007677:Kidney Function Tests; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000209:etiology / Q000517:prevention & control* / Q000652:urine; D013997:Time Factors; D000077602:Tolvaptan; D014554:Urination / Q000187:drug effects / Q000502:physiology
chemical_list: D001552:Benzazepines; D004232:Diuretics; D020097:Natriuretic Peptide, Brain; D000077602:Tolvaptan; D005665:Furosemide; D003404:Creatinine