title: Effects of tolvaptan in patients with chronic kidney disease and chronic heart failure.
abstract: BACKGROUND
  Tolvaptan, a vasopressin V2receptor blocker, has a diuretic effect for patients with heart failure. However, there were a few data concerning the effects of tolvaptan in patients with chronic kidney disease (CKD).
  
  
  METHODS
  We retrospectively analyzed 21 patients with chronic heart failure and CKD. Tolvaptan was co-administered with other diuretics in-use, every day. We compared clinical parameters before and after the treatments with tolvaptan. Furthermore, we examined the correlations between baseline data and the change of body weight.
  
  
  RESULTS
  Tolvaptan decreased the body weight and increased the urine volume (p = 0.001). The urine osmolality significantly decreased throughout the study period. Urinary Na/Cr ratio and FENa changed significantly after 4 h, and more remarkable after 8 h (p = 0.003, both). Serum creatinine increased slightly after 1 week of treatment (p = 0.012). The alteration of body weight within the study period correlated negatively with the baseline urine osmolality (r = -0.479, p = 0.038), the baseline urine volume (r = -0.48, p = 0.028), and the baseline inferior vena cava diameter (IVCD) (r = -0.622, p = 0.017). Hyponatremia was improved to the normal value, and the augmentations of the sodium concentration were negatively associated with the basal sodium levels (p = 0.01, r = -0.546).
  
  
  CONCLUSIONS
  Tolvaptan is effective in increasing diuresis and improved hyponatremia, even in patients with CKD. The baseline urine osmolality, urine volume, and IVCD may be useful predictors for diuretic effects of tolvaptan.
authors.affiliation: Department of Nephrology and Hypertension, Yokohama City University Medical Center, 45-7 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Katsumata
authors.affiliation: Department of Nephrology and Hypertension, Yokohama City University Medical Center, 45-7 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
authors.forename: Nobuhito
authors.identifier: http://orcid.org/0000-0001-5824-3652
authors.initials: N
authors.lastname: Hirawa
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Sumida
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Minako
authors.initials: M
authors.lastname: Kagimoto
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Ehara
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Okuyama
authors.affiliation: Department of Nephrology and Hypertension, Yokohama City University Medical Center, 45-7 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Fujita
authors.affiliation: Department of Nephrology and Hypertension, Yokohama City University Medical Center, 45-7 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Fujiwara
authors.affiliation: Department of Nephrology and Hypertension, Yokohama City University Medical Center, 45-7 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Nephrology, Yokosuka City Hospital, Yokosuka, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: Department of Nephrology and Hypertension, Yokohama City University Medical Center, 45-7 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Nephrology and Hypertension, Yokohama City University Medical Center, 45-7 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
authors.forename: Sanae
authors.initials: S
authors.lastname: Saka
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Yatsu
authors.affiliation: Center for Health Service Sciences, Yokohama National University, Yokohama, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fujikawa
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Toya
authors.affiliation: Department of Nephrology and Hypertension, Yokohama City University Medical Center, 45-7 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
authors.forename: Gen
authors.initials: G
authors.lastname: Yasuda
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Kouichi
authors.initials: K
authors.lastname: Tamura
authors.affiliation: Yokohama Rosai Hospital, Yokohama, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Umemura
mesh_terms: D000368:Aged; D065092:Antidiuretic Hormone Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D001552:Benzazepines / Q000009:adverse effects / Q000627:therapeutic use*; D004231:Diuresis / Q000187:drug effects; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D065667:Renal Elimination / Q000187:drug effects; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood / Q000652:urine; D013997:Time Factors; D000077602:Tolvaptan; D016896:Treatment Outcome; D014556:Urine / Q000737:chemistry; D014563:Urodynamics / Q000187:drug effects; D015431:Weight Loss / Q000187:drug effects
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D004232:Diuretics; D000077602:Tolvaptan; D012964:Sodium
keywords: Chronic kidney disease; Hyponatremia; Tolvaptan; Urine osmolality