Amiodarone-Induced Hyponatremia Masked by Tolvaptan in a Patient with an Implantable Left Ventricular Assist Device

Sunagawa, Osahiko; Kugai, Tadao; Kinugawa, Koichiro

doi:10.1536/ihj.16-656

Cited by 7 publications

(6 citation statements)

References 17 publications

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“…Several studies, including our data, have shown that although TLV had favorable effects, including a renoprotective effect in the acute phase of ADHF, TLV could not show any favorable long-term clinical outcomes [6,22,23]. Although several Japanese reports showed a favorable long-term effect on very limited HF patients [7,8,27], it may not be valuable in the clinical settings because these data cannot apply to all ADHF patients. In addition, recently, the guideline-based medical therapy (GDMT) for HF included sodiumglucose cotransporter (SGLT) 2 inhibitors [28] because SGLT2 inhibitors have been to have a strong clinical impact on HF [29,30].…”

Section: Discussionmentioning

confidence: 58%

“…However, in Japan, many HF patients receive long-term TLV therapy [3], probably considering the favorable clinical response of TLV experienced by clinicians and approval when an adequate response is not obtained by other diuretics since December in Japan [24]. Recent long-term studies using TLV in Japan revealed relatively favorable TLV effects on HF patients, but in very limited patients who had many high-risk factors for rehospitalizations or who were possible TLV responders whose urine osmolality was ≥350 mOsm/L, which was a predictive marker of TLV responders [4,5,7]. Thus, in general, the long-term effect of TLV in HF patients cannot be sufficiently expected.…”

Section: Effect Of Tlv On One-year All-cause Mortality and Rehospital...mentioning

confidence: 99%

“…The first prospective and randomized long-term trial, EVEREST, resulted in neither an improvement nor reduction in the survival nor in the combined endpoint of cardiovascular mortality or HF hospitalizations for a 2-year TLV therapy [6]. However, recent long-term studies using TLV, particularly in Japan, revealed partially favorable TLV effects on HF patients [7,8]. Additionally, whether the renoprotective effect of TLV can be continued or not for a long-term period is unclear.…”

Section: Introductionmentioning

confidence: 99%

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Temporal Change in Renoprotective Effect of Tolvaptan on Patients with Heart Failure: AURORA Study

Nishino¹,

Egami²,

Tanaka³

et al. 2022

JCM

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(1) Background: It has been reported that tolvaptan (TLV) has a renoprotective effect in acute decompensated heart failure (ADHF) patients, but whether this effect is continued for a long time is unclear. Thus, we evaluated the time course of the renoprotective effect of TLV, in addition to the prognosis, in ADHF patients. (2) Methods: We investigated 911 ADHF patients from the AURORA (Acute Heart Failure Registry in Osaka Rosai Hospital) registry. After propensity score matching, 58 patients who started to receive TLV at least two days after the hospitalization (TLV group) and 58 who did not (non-TLV group) were examined. We compared the changes in the creatinine (Cr) and estimated glomerular filtration rate (eGFR) between baseline and each time point (five days, discharge, and one year) as the index of the renoprotective effect, and rate of rehospitalizations and all-cause mortality for one year between the two groups. (3) Results: The change in Cr and eGFR levels was significantly higher in the TLV group than the non-TLV group five days after admission but the difference between the two groups gradually diminished. A Kaplan–Meier analysis showed that the survival and rehospitalization rates in the TLV and non-TLV groups were similar up to one year. (4) TLV revealed a temporal change in the renoprotective effect, which may be correlated with no long-term beneficial effect of TLV.

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Section: Discussionmentioning

confidence: 58%

Section: Effect Of Tlv On One-year All-cause Mortality and Rehospital...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Temporal Change in Renoprotective Effect of Tolvaptan on Patients with Heart Failure: AURORA Study

Nishino¹,

Egami²,

Tanaka³

et al. 2022

JCM

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“…26 The first case report was published in 1996. 27 The mechanism by which amiodarone induces SIADH is still unclear. 28 Iovino et al suggested that amiodarone causes SIADH by stimulating anti-diuretic hormone secretion by the magnocellular neurons in the supraoptic and paraventricular nuclei of the hypothalamus or through the expression of water channel aquaporin-2 (AQP2) in the collecting ducts.…”

Section: Discussionmentioning

confidence: 99%

Hyponatremia in elderly patients with fragility fractures of the proximal femur: a cross-sectional study

2019

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Introduction: Proximal femur fractures affect the mortality and morbidity of elderly individuals. Recent studies have shown an association between fragility fractures and hyponatremia, a common fluid and electrolyte balance disorder. Objectives: This study aimed to investigate the occurrence of hyponatremia in patients with fragility fractures of the proximal femur. Methods: The authors looked into the data from the medical records of patients admitted to the emergency unit of the Real Hospital Português for fragility fractures of the proximal femur from 2014 to 2017. The study included patients with serum sodium levels recorded in their charts. Results: Fourteen of 69 (20.3%) patients with proximal femur fractures had hyponatremia. The main factors linked to hyponatremia were lung disease, and prescription of amiodarone and/or antidepressants. Conclusion: In elderly individuals, fragility fractures of the proximal femur may correlate with hyponatremia, particularly among patients on amiodarone or antidepressants.

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“… 1–4 The American Heart Association/the American College of Cardiology guideline for heart failure management suggests that the appropriate timing of beta-blocker initiation is when patients no longer require inotropes. 2 However, several real-world studies 5–7 and case reports 8–12 indicate that beta-blockers are sometimes initiated concurrently with dobutamine infusion.…”

Section: Introductionmentioning

confidence: 99%

Beta-blocker initiation under dobutamine infusion in acute advanced heart failure: a target trial emulation with observational data

Mori,

Inoue,

Sato

et al. 2024

European Heart Journal Open

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Background In patients with advanced heart failure requiring dobutamine infusion, it is usually recommended to initiate beta-blockers after weaning from dobutamine. However, beta-blockers are sometimes initiated under dobutamine infusion in the real world. The association between such early beta-blocker initiation with clinical outcomes is unknown. Therefore, the study investigated the association between initiating beta-blockers under dobutamine infusion and survival outcomes. Methods This observational study with a multicenter inpatient-care database emulated a pragmatic randomized controlled trial of the beta-blocker initiation strategy. First, 1,151 patients on dobutamine and not on beta-blockers on the day of heart failure admission (day 0) were identified. Among 1,095 who met eligibility criteria, patients who eventually initiated beta-blockers under dobutamine infusion by day 7 (early initiation strategy) were 1:1 matched to those who did not (conservative strategy). The methods of cloning, censoring, and weighting were applied to emulate the target trial. Patients were followed for up to 30 days. The primary outcome was all-cause death. Results Among 780 matched patients (median age, 81 years), the adjusted hazard ratio was 1.11 (95% confidence interval: 0.75–1.64, p = 0.59) for the early initiation strategy. The estimated 30-day all-cause mortalities in the early initiation strategy and the conservative strategy were 19.3% (10.6–30.7) and 16.2% (9.2–25.3), respectively. The results were consistent when we used different days to determine strategies (i.e., five and nine) instead of seven days. Conclusions The present observational study emulating a pragmatic randomized controlled trial found no positive or negative association between beta-blocker initiation under dobutamine infusion and overall survival.

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Amiodarone-Induced Hyponatremia Masked by Tolvaptan in a Patient with an Implantable Left Ventricular Assist Device

Cited by 7 publications

References 17 publications

Temporal Change in Renoprotective Effect of Tolvaptan on Patients with Heart Failure: AURORA Study

Temporal Change in Renoprotective Effect of Tolvaptan on Patients with Heart Failure: AURORA Study

Hyponatremia in elderly patients with fragility fractures of the proximal femur: a cross-sectional study

Beta-blocker initiation under dobutamine infusion in acute advanced heart failure: a target trial emulation with observational data

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