Randomized pilot trial comparing tolvaptan with furosemide on renal and neurohumoral effects in acute heart failure.
OBJECTIVE
Loop diuretics are first-line medications for congestive heart failure (CHF); however, they are associated with serious adverse effects, including decreased renal function, and sympathetic nervous and renin-angiotensin system activation. We tested whether tolvaptan, a vasopressin V2-receptor antagonist, could reduce unfavourable furosemide-induced effects during CHF treatment.


RESULTS
Sixty patients emergently hospitalized owing to CHF-induced dyspnea were randomly assigned to receive either 40 mg intravenous furosemide daily or 7.5 mg oral tolvaptan for 5 days after admission. Both groups also received intravenous carperitide and canrenoate potassium. As results, baseline patient characteristics were similar between the furosemide (n= 30) and the tolvaptan (n= 30) groups, with no significant difference in 5 day urine volume or fluid balance. Brain natriuretic peptide and body weight improvements were similar between groups. However, serum creatinine (Cr) level did not increase, and the incidence of worsening renal function was significantly lower in the tolvaptan group. Consequently, the Cr increase to gain 1000 mL urine was 2.5-fold lower in the tolvaptan group. Furthermore, the blood urea nitrogen (BUN)/Cr ratio significantly decreased in the tolvaptan group, suggesting that renal perfusion was preserved, and urea reuptake and passive water reabsorption were suppressed following tolvaptan treatment. Although catecholamine improvements after treatment were not significantly different, plasma renin activity was enhanced in the furosemide group.


CONCLUSIONS
As compared with furosemide, tolvaptan in patients with acute heart failure is associated with comparable decongestion, better preservation of renal function and less activation of renin-angiotensin system. (UMIN 000014134).
Department of CardiologyTokyo Women's Medical UniversityTokyoJapan; Department of CardiologyNishiarai Heart Center HospitalTokyoJapan.
Kentaro
0000-0002-2011-8204
K
Jujo
Department of Cardiology Nishiarai Heart Center Hospital Tokyo Japan.
Katsumi
K
Saito
Department of Cardiology Nishiarai Heart Center Hospital Tokyo Japan.
Issei
I
Ishida
Department of Cardiology Nishiarai Heart Center Hospital Tokyo Japan.
Yuho
Y
Furuki
Department of Cardiology Nishiarai Heart Center Hospital Tokyo Japan.
Ahsung
A
Kim
Department of Cardiology Nishiarai Heart Center Hospital Tokyo Japan.
Yuki
Y
Suzuki
Department of Cardiology, Aoyama Hospital Tokyo Women's Medical University Tokyo Japan.
Haruki
H
Sekiguchi
Department of Cardiology Tokyo Women's Medical University Tokyo Japan.
Junichi
J
Yamaguchi
Department of Cardiology Tokyo Women's Medical University Tokyo Japan.
Hiroshi
H
Ogawa
Department of Cardiology Tokyo Women's Medical University Tokyo Japan.
Nobuhisa
N
Hagiwara
Diuretic; Heart failure; Kidney; Pharmacology