title: Early administration of tolvaptan preserves renal function in elderly patients with acute decompensated heart failure.
abstract: BACKGROUND
  Loop diuretics used in the treatment of heart failure often induce renal impairment. This study was conducted in order to evaluate the renal protective effect of adding tolvaptan (TLV), compared to increasing the furosemide (FRM) dose, for the treatment of acute decompensated heart failure (ADHF) in a real-world elderly patient population.
  
  
  METHODS
  This randomized controlled trial enrolled 52 consecutive hospitalized patients (age 83.4±9.6 years) with ADHF. The patients were assigned alternately to either the TLV group (TLV plus conventional treatment, n=26) or the FRM group (increasing the dose of FRM, n=26). TLV was administered within 24h from admission.
  
  
  RESULTS
  The incidence of worsening renal function (WRF) within 7 days from admission was significantly lower in the TLV group (26.9% vs. 57.7%, p=0.025). Furthermore, the rates of occurrence of persistent and late-onset (≥5 days from admission) WRF were significantly lower in the TLV group. Persistent and late-onset WRF were significantly associated with a higher incidence of cardiac death or readmission for worsening heart failure in the 90 days following discharge, compared to transient and early-onset WRF, respectively.
  
  
  CONCLUSIONS
  Early administration of TLV, compared to increased FRM dosage, reduces the incidence of WRF in real-world elderly ADHF patients. In addition, it reduces the occurrence of 'worse' WRF-persistent and late-onset WRF-which are associated with increased rates of cardiac death or readmission for worsening heart failure in the 90 days after discharge.
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano 390-8621, Japan; Department of Cardiovascular Medicine, Nagano Matsushiro General Hospital, Matsushiro 183, Matsudhiro-machi, Nagano, Nagano 381-1231, Japan. Electronic address: kaz_kimura@shishu-u.ac.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Cardiovascular Medicine, Nagano Matsushiro General Hospital, Matsushiro 183, Matsudhiro-machi, Nagano, Nagano 381-1231, Japan.
authors.forename: Tomoyasu
authors.initials: T
authors.lastname: Momose
authors.affiliation: Department of Cardiovascular Medicine, Nagano Matsushiro General Hospital, Matsushiro 183, Matsudhiro-machi, Nagano, Nagano 381-1231, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Hasegawa
authors.affiliation: Department of Cardiovascular Medicine, Nagano Matsushiro General Hospital, Matsushiro 183, Matsudhiro-machi, Nagano, Nagano 381-1231, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Morita
authors.affiliation: Department of Cardiovascular Medicine, Nagano Matsushiro General Hospital, Matsushiro 183, Matsudhiro-machi, Nagano, Nagano 381-1231, Japan.
authors.forename: Takuo
authors.initials: T
authors.lastname: Misawa
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Motoki
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Izawa
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Uichi
authors.initials: U
authors.lastname: Ikeda
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D065092:Antidiuretic Hormone Receptor Antagonists / Q000627:therapeutic use*; D001552:Benzazepines / Q000627:therapeutic use*; D004232:Diuretics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005665:Furosemide / Q000627:therapeutic use*; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D051437:Renal Insufficiency / Q000209:etiology / Q000517:prevention & control*; D000077602:Tolvaptan
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D004232:Diuretics; D000077602:Tolvaptan; D005665:Furosemide
keywords: Acute decompensated heart failure; Elderly; Furosemide; Tolvaptan; Worsening renal function