title: Clinical benefit of tolvaptan in patients with acute decompensated heart failure and chronic kidney disease.
abstract: Tolvaptan, a vasopressin type 2 receptor antagonist, has an aquaretic effect without affecting renal function. The effects of long-term tolvaptan administration in heart failure patients with renal dysfunction have not been clarified. Here, we assessed the clinical benefit of tolvaptan during a 6-month follow-up in acute decompensated heart failure (ADHF) patients with severe chronic kidney disease (CKD; estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m(2)). We compared 33 patients with ADHF and severe CKD who were administered tolvaptan in addition to loop diuretics (TLV group), with 36 patients with ADHF and severe CKD who were administered high-dose loop diuretics (≥40 mg) alone (LD group). Alterations in serum creatinine and eGFR levels from the time of hospital discharge to 6-month follow-up were significantly different between the groups, with those in the TLV group being more favorable. Furthermore, Kaplan-Meier analysis revealed that rehospitalization for heart failure (HF) was significantly lower in the TLV group compared with the LD group. In ADHF patients with severe CKD, tolvaptan use for 6 months reduced worsening of renal function and rehospitalization rates for HF when compared with conventional diuretic therapy. In conclusion, tolvaptan could be a safe and effective agent for long-term management of HF and CKD.
authors.affiliation: Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo, 466-8602, Japan. yusuke0307@kosei.anjo.aichi.jp.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Uemura
authors.affiliation: Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Rei
authors.initials: R
authors.lastname: Shibata
authors.affiliation: Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo, 466-8602, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Takemoto
authors.affiliation: Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo, 466-8602, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Uchikawa
authors.affiliation: Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo, 466-8602, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Koyasu
authors.affiliation: Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo, 466-8602, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Ishikawa
authors.affiliation: Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo, 466-8602, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Mitsuda
authors.affiliation: Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo, 466-8602, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Miura
authors.affiliation: Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo, 466-8602, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Imai
authors.affiliation: Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo, 466-8602, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Iwamiya
authors.affiliation: Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo, 466-8602, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Ozaki
authors.affiliation: Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo, 466-8602, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kato
authors.affiliation: Education and Clinical Research Center, Anjo Kosei Hospital, Anjo, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Miura
authors.affiliation: Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo, 466-8602, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Watarai
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D065092:Antidiuretic Hormone Receptor Antagonists / Q000008:administration & dosage*; D001552:Benzazepines / Q000008:administration & dosage*; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012189:Retrospective Studies; D000077602:Tolvaptan
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D000077602:Tolvaptan; D003404:Creatinine
keywords: Aquaretic; Chronic kidney disease; Heart failure; Tolvaptan