title: Immediate administration of tolvaptan prevents the exacerbation of acute kidney injury and improves the mid-term prognosis of patients with severely decompensated acute heart failure.
abstract: BACKGROUND
  Tolvaptan, an oral selective vasopressin 2 receptor antagonist that acts on the distal nephrons to cause a loss of electrolyte-free water, is rarely used during the acute phase of acute heart failure (AHF).
  
  
  RESULTS
  We investigated 183 AHF patients admitted to the intensive care unit and administered tolvaptan (7.5mg) with continuous intravenous furosemide, and then additionally at 12-h intervals until HF was compensated. When intravenous furosemide was changed to peroral use, the administration of tolvaptan was stopped. The patients were assigned to tolvaptan (n=52) or conventional treatment (n=131) groups. The amount of intravenous furosemide was significantly lower (35.4 [16.3-56.0] mg vs. 80.0 [30.4-220.0] mg), the urine volume was significantly higher on days 1 and 2 (3,691 [3,109-4,198] ml and 2,953 [2,128-3,592] ml vs. 2,270 [1,535-3,258] ml and 2,129 [1,407-2,906] ml) and the numbers of patients with worsening-AKI (step-up RIFLE Class to I or F) and Class F were significantly fewer (5.8% and 1.9% vs. 19.1% and 16.0%) in the tolvaptan group than in the conventional group, respectively. One of the specific medications indicated worsening-AKI and in-hospital mortality was tolvaptan (odds ratio [OR] 0.155, 95% confidence interval [CI] 0.037-0.657 and OR 0.191, 95% CI 0.037-0.985). The Kaplan-Meier curves showed that the death rate within 6 months was significantly lower in the tolvaptan group. The same result was found after propensity matching of the data.
  
  
  CONCLUSIONS
  Early administration of tolvaptan could prevent exacerbation of AKI and improve the prognosis for AHF patients.
authors.affiliation: Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Shirakabe
authors.forename: Noritake
authors.initials: N
authors.lastname: Hata
authors.forename: Masanori
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Takuro
authors.initials: T
authors.lastname: Shinada
authors.forename: Kazunori
authors.initials: K
authors.lastname: Tomita
authors.forename: Masafumi
authors.initials: M
authors.lastname: Tsurumi
authors.forename: Masato
authors.initials: M
authors.lastname: Matsushita
authors.forename: Hirotake
authors.initials: H
authors.lastname: Okazaki
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Shinya
authors.initials: S
authors.lastname: Yokoyama
authors.forename: Kuniya
authors.initials: K
authors.lastname: Asai
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors; D000077602:Tolvaptan
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D000077602:Tolvaptan