title: Clinical characteristics of responders to treatment with tolvaptan in patients with acute decompensated heart failure: Importance of preserved kidney size.
abstract: BACKGROUND
  Recent clinical trials have demonstrated the efficacy of short-term treatment with tolvaptan, an oral vasopressin V2 receptor antagonist, in patients with heart failure. However, the response to tolvaptan varies among patients. The aim of this study was to determine factors associated with response to tolvaptan in patients with acute decompensated heart failure (ADHF).
  
  
  METHODS
  The Tolvaptan Registry, a prospective, observational, multicenter cohort study performed in Japan, aims to determine factors affecting the responsiveness of tolvaptan in patients with ADHF. We enrolled ADHF patients treated with tolvaptan and they were divided into two groups: responders and non-responders. Responders were defined as subjects who met all of the following three conditions: (1) increasing urine volume during a 24-hour period after the start of tolvaptan treatment; (2) improvement in New York Heart Association functional class; and (3) decrease in cardiothoracic ratio assessed by chest X-ray on day 3 of tolvaptan administration.
  
  
  RESULTS
  Among the 114 patients, treatment with tolvaptan improved three conditions of heart failure in more than half of all the cohorts (71 patients, 62%). As for baseline characteristics, estimated glomerular filtration rate, urine osmolality, and kidney size were significantly greater in responders than in non-responders. Multivariate logistic analysis revealed that kidney size was independently associated with responders (odds ratio: 1.083, p=0.001, 95% confidence interval 1.031-1.137).
  
  
  CONCLUSIONS
  The main clinical characteristic of responders to treatment with tolvaptan is that kidney size is preserved.
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of Cardiology, Fukuyama City Hospital, Fukuyama, Japan. Electronic address: hiromail1979@yahoo.co.jp.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Toda
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. Electronic address: ichibun@cc.okayama-u.ac.jp.
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Cardiology, Fukuyama City Hospital, Fukuyama, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Nakahama
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of Cardiology, Fukuyama City Hospital, Fukuyama, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Wada
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of Cardiology, Fukuyama City Hospital, Fukuyama, Japan.
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Watanabe
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of Cardiology, Fukuyama City Hospital, Fukuyama, Japan.
authors.forename: Katsushi
authors.initials: K
authors.lastname: Hashimoto
authors.affiliation: Department of Cardiology, Fukuyama City Hospital, Fukuyama, Japan.
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Terasaka
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Tokioka
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Nishii
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Miyoshi
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Kunihisa
authors.initials: K
authors.lastname: Kohno
authors.affiliation: Department of Cardiology, Ehime Prefectural Central Hospital, Ehime, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kawai
authors.affiliation: Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Miyaji
authors.affiliation: Department of Cardiovascular Medicine, Mitoyo General Hospital, Kagawa, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Koide
authors.affiliation: Department of Cardiology, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan.
authors.forename: Motomi
authors.initials: M
authors.lastname: Tachibana
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Yoshioka
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
mesh_terms: D000208:Acute Disease; D000368:Aged; D065092:Antidiuretic Hormone Receptor Antagonists / Q000627:therapeutic use*; D001552:Benzazepines / Q000627:therapeutic use*; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology / Q000652:urine; D006801:Humans; D007564:Japan; D007668:Kidney / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009929:Organ Size / Q000187:drug effects; D009994:Osmolar Concentration; D011446:Prospective Studies; D000077602:Tolvaptan
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D000077602:Tolvaptan
keywords: Heart failure; Kidney size; Vasopressin