title: The effects of tolvaptan on patients with severe chronic kidney disease complicated by congestive heart failure.
abstract: BACKGROUND
  Tolvaptan, a diuretic with a new mechanism of action, selectively binds to the vasopressin V2 receptor and inhibits reabsorption of water. Its effect on heart failure is proven, but its benefit for patients with chronic kidney disease (CKD) has not been not confirmed. In this study, we examined the effect of tolvaptan on patients with severe CKD.
  
  
  METHODS
  We analyzed patients with stage 4 or higher CKD who had congestive heart failure that was resistant to existing diuretics. The patients were administered an initial tolvaptan dose of 7.5 mg/day. We assumed urine volume and urine osmolality to be the main effective endpoint and recorded free water clearance, serum osmolality, serum creatinine (Cr) level, and adverse events.
  
  
  RESULTS
  There was no instance of clinically significant hypernatremia. The urine volume increased significantly (P < 0.0001), as did the urine osmolality (P = 0.0053). Free water clearance showed a tendency to increase, although the difference was not statistically significant. The serum creatinine level did not change significantly, and there was no clear effect on renal function. However, in patients with stage 5 CKD, the serum creatinine level decreased significantly (n = 5, P = 0.0435). There were no adverse events.
  
  
  CONCLUSIONS
  We confirmed that tolvaptan has a diuretic effect in patients with both severe CKD and congestive heart failure without causing either clinically significant hypernatremia or an adverse effect on renal function. Tolvaptan is an effective diuretic for patients with CKD.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, 211-8533, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Otsuka
authors.forename: Yukinao
authors.initials: Y
authors.lastname: Sakai
authors.forename: Dai
authors.initials: D
authors.lastname: Ohno
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Murasawa
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
authors.forename: Shuichi
authors.initials: S
authors.lastname: Tsuruoka
mesh_terms: D000368:Aged; D001552:Benzazepines / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D004232:Diuretics / Q000627:therapeutic use*; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy* / Q000652:urine; D012189:Retrospective Studies; D000077602:Tolvaptan
chemical_list: D001552:Benzazepines; D004232:Diuretics; D000077602:Tolvaptan; D003404:Creatinine