title: The Efficacy of Tolvaptan in Congestive Heart Failure Patients with and Without Hypoalbuminemia: A Pilot Study.
abstract: BACKGROUND
  Heart failure (HF) with hypoalbuminemia is associated with poor response to conventional therapy. We investigated whether tolvaptan, a potent aquaretic agent, might be of benefit in HF patients with hypoalbuminemia.
  
  
  METHODS
  We prospectively enrolled 40 patients hospitalized for HF. Patients received conventional therapy including loop diuretics. We subsequently added tolvaptan in the range of 3.75-15 mg daily and it was discontinued after improvement of HF symptoms. We compared clinical and laboratory data in HF patients with and without hypoalbuminemia (defined as serum albumin <3.0 g/dL).
  
  
  RESULTS
  Tolvaptan was administered in 18 HF patients with hypoalbuminemia (Group A) and 22 HF patients without hypoalbuminemia (Group B). The mean serum albumin was 2.63 ± 0.27 and 3.46 ± 0.25 g/dL, respectively. The average urine output on tolvaptan increased significantly in both groups (1644.4 ± 797.6-3011.6 ± 1453.8 mL/day, P = 0.004; 1459 ± 612.7-2112.2 ± 724.5 mL/day, P = 0.008; respectively). In addition, we observed higher urine output on therapy in Group A than in Group B (P = 0.015). There was a moderate negative correlation between serum albumin and average urine output on tolvaptan (r = -0.42, P = 0.007).
  
  
  CONCLUSIONS
  The addition of tolvaptan to low dose loop diuretics might be an effective strategy for treatment of HF patients with hypoalbuminemia.
authors.affiliation: Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan.
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Okabe
authors.affiliation: Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan.
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Yakushiji
authors.affiliation: Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Igawa
authors.affiliation: Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan.
authors.forename: Morio
authors.initials: M
authors.lastname: Ono
authors.affiliation: Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Kido
authors.affiliation: Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan.
authors.forename: Seitaro
authors.initials: S
authors.lastname: Ebara
authors.affiliation: Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan.
authors.forename: Kennosuke
authors.initials: K
authors.lastname: Yamashita
authors.affiliation: Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan.
authors.forename: Myong Hwa
authors.initials: MH
authors.lastname: Yamamoto
authors.affiliation: Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Saito
authors.affiliation: Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hoshimoto
authors.affiliation: Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan.
authors.forename: Kisaki
authors.initials: K
authors.lastname: Amemiya
authors.affiliation: Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan.
authors.forename: Naoei
authors.initials: N
authors.lastname: Isomura
authors.affiliation: Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Araki
authors.affiliation: Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ochiai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D065092:Antidiuretic Hormone Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D001552:Benzazepines / Q000008:administration & dosage / Q000627:therapeutic use*; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012709:Serum Albumin / Q000032:analysis; D000077602:Tolvaptan; D059349:Urine Specimen Collection
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D004232:Diuretics; D012709:Serum Albumin; D000077602:Tolvaptan
keywords: Diuretics; Heart failure; Hypoalbuminemia; Tolvaptan