Background: 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. Methods and Results: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. Conclusions:Tolvaptan can alleviate congestion with a significantly lower risk of WRF in ADHF patients with preserved LVEF, presumably through maintenance of renal perfusion.

Both persistent hypochloremia and progressive hypochloremia during hospitalization are associated with HFD in ADHF patients.

Climate change (CC) is one of the primary threats to the agricultural sector in developing countries. Several empirical studies have shown that the implementation of adaptation practices can reduce the adverse effects of CC. The likelihood of farmers performing adaptation practices is mostly influenced by the degree of CC impact that they perceive. Thus, we identified the characteristics of farmers that affect the degree of the CC impact that they perceive. We used data from the Indonesian Rice Farm Household survey consisting of 87,330 farmers. An ordered probit regression model was used to estimate the effect of each variable on the degree of the perceived impact of CC. The results of this study confirm those of previous empirical studies. Several variables that have been identified as having a positive effect on farmer adaptation practices, such as farmer education, land tenure, irrigation infrastructure, cropping system, chemical fertilizer application, access to extension services, and participation in farmer groups, negatively affect the degree of the perceived impact of CC. However, a different result was found in the estimation of the gender variable. We found that female farmers have a higher CC resilience and ability to withstand climatic shocks and risks than male farmers. Female farmers have a more positive perception of future farming conditions than male farmers. We recommend the implementation of a national adaptation policy that use and expand the channel of agricultural extension services to deliver the planned adaptation policy, and prioritizes farmers with insecure land tenure. Additionally, we encourage the increasing of female involvement in the CC adaptation practices and decision-making processes.

The ambulatory ECG-based FD-TWA might be useful to detect patients with ICD who are at high risk for ventricular tachyarrhythmias, and the combination of FD-TWA and HRV might improve the ability to detect such high-risk patients.