title: Tolvaptan Reduces the Risk of Worsening Renal Function in Patients With Acute Decompensated Heart Failure and Preserved Left Ventricular Ejection Fraction　- Prospective Randomized Controlled Study.
abstract: Although the mainstay of treatment for acute decompensated heart failure (ADHF) is decongestion by diuretic therapy, it is often associated with worsening renal function (WRF). The effect of tolvaptan, a selective V2 receptor antagonist, on WRF in ADHF patients with preserved left ventricular ejection fraction (LVEF) is unknown.
  
  
  
  We enrolled 50 consecutive ADHF patients whose LVEF on admission was ≥45%. Patients were randomly assigned to either tolvaptan add-on (n=26) or conventional diuretic therapy (n=24). The primary endpoint was the incidence of WRF, defined as an increase in serum creatinine (Cr) ≥0.3 mg/dL or 50% above baseline within 48 h of randomization. There was no significant difference between the 2 groups in the change in body weight or the total urine volume during 48 h. However, the change in Cr (∆Cr) at 24 and 48 h after randomization and the incidence of WRF (12% vs. 42%, P=0.0236) were significantly lower, and the fractional excretion of urea (FEUN) at 24 and 48 h after randomization was significantly higher in the tolvaptan group. There was an inverse correlation between ∆Cr and FEUN at 48 h after randomization.
  
  
  
  Tolvaptan can alleviate congestion with a significantly lower risk of WRF in ADHF patients with preserved LVEF, presumably through maintenance of renal perfusion.
authors.affiliation: Division of Cardiology, Osaka General Medical Center.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Tamaki
authors.affiliation: Division of Cardiology, Osaka General Medical Center.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Division of Cardiology, Osaka General Medical Center.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Division of Cardiology, Osaka General Medical Center.
authors.forename: Takashi
authors.initials: T
authors.lastname: Morita
authors.affiliation: Division of Cardiology, Osaka General Medical Center.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Furukawa
authors.affiliation: Division of Cardiology, Osaka General Medical Center.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Iwasaki
authors.affiliation: Division of Cardiology, Osaka General Medical Center.
authors.forename: Masato
authors.initials: M
authors.lastname: Kawasaki
authors.affiliation: Division of Cardiology, Osaka General Medical Center.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kikuchi
authors.affiliation: Division of Cardiology, Osaka General Medical Center.
authors.forename: Takumi
authors.initials: T
authors.lastname: Kondo
authors.affiliation: Division of Cardiology, Osaka General Medical Center.
authors.forename: Tatsuhisa
authors.initials: T
authors.lastname: Ozaki
authors.affiliation: Division of Cardiology, Osaka General Medical Center.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Seo
authors.affiliation: Division of Cardiology, Osaka General Medical Center.
authors.forename: Iyo
authors.initials: I
authors.lastname: Ikeda
authors.affiliation: Division of Cardiology, Osaka General Medical Center.
authors.forename: Eiji
authors.initials: E
authors.lastname: Fukuhara
authors.affiliation: Division of Cardiology, Osaka General Medical Center.
authors.forename: Makoto
authors.initials: M
authors.lastname: Abe
authors.affiliation: Division of Cardiology, Osaka General Medical Center.
authors.forename: Jun
authors.initials: J
authors.lastname: Nakamura
authors.affiliation: Division of Cardiology, Osaka General Medical Center.
authors.forename: Masatake
authors.initials: M
authors.lastname: Fukunami
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D000077602:Tolvaptan; D014508:Urea / Q000032:analysis; D016277:Ventricular Function, Left; D055815:Young Adult
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D004232:Diuretics; D000077602:Tolvaptan; D014508:Urea; D003404:Creatinine
keywords: Acute decompensated heart failure; Diuretics; Renal function