Clinical Effectiveness of Tolvaptan in Patients With Acute Heart Failure and Renal Dysfunction

Matsue, Yuya; Suzuki, Makoto; Torii, Sho; Yamaguchi, Satoshi; Fukamizu, Seiji; Ono, Yūichi; Fujii, H.; Kitai, Takeshi; Nishioka, Toshihiko; Sugi, Kaoru; Onishi, Yuko; Noda, Makoto; Kagiyama, Nobuyuki; Satoh, Yasuhiro; Yoshida, Kazuki; Goldsmith, Steven R.

doi:10.1016/j.cardfail.2016.02.007

Cited by 105 publications

(134 citation statements)

References 35 publications

Supporting

Mentioning

126

Contrasting

Unclassified

Order By: Relevance

“…Previous studies of TLV use were tested in acute HF without accounting for diuretic resistance. [8][9][10][11] There are 3 main findings of the present study. First, additive TLV resulted in significantly higher UV than increased FUR, primarily through increased urinary water excretion in HF patients with residual congestion despite concomitant FUR.…”

Section: Discussionmentioning

confidence: 52%

Effects of Additive Tolvaptan vs. Increased Furosemide on Heart Failure With Diuretic Resistance and Renal Impairment　― Results From the K-STAR Study ―

Inomata

Ikeda

Kida

et al. 2018

Circ J

View full text Add to dashboard Cite

Background: Although diuretic resistance leading to residual congestion is a known predictor of a poorer heart failure (HF) prognosis, better therapeutic strategies for effective and safe decongestion have not been established. Methods and Results:In this study, 81 HF patients with fluid retention (despite taking ≥40 mg/day furosemide (FUR)), with an estimated glomerular filtration rate <45 mL/min/1.73 m 2 , were randomized into 2 groups and administered either ≤15 mg/day additive tolvaptan (TLV) or ≤40 mg/day increased FUR for 7 days. Changes in urine volume between baseline and mean urine volume during treatment were significantly higher in the TLV than FUR group (P=0.0003). Although there was no significant decrease in body weight or improved signs and symptoms of congestion between the 2 groups, the increase in serum creatinine on Day 7 from baseline was significantly smaller in the TLV than FUR group (P=0.038). Multiple logistic regression analysis revealed that additive TLV (odds ratio 0.157, 95% confidence interval 0.043-0.605, P=0.001) was an independent clinical factor for improved renal function during treatment compared with increased FUR. Conclusions:In HF patients with residual congestion and renal dysfunction refractory to standard therapy, additive TLV increased urine volume without further renal impairment compared with patients who received an increased dose of FUR.

show abstract

Section: Discussionmentioning

confidence: 52%

Effects of Additive Tolvaptan vs. Increased Furosemide on Heart Failure With Diuretic Resistance and Renal Impairment　― Results From the K-STAR Study ―

Inomata

Ikeda

Kida

et al. 2018

Circ J

View full text Add to dashboard Cite

show abstract

“…It is possible that adequate fluid control can be achieved with TLV administration alone, without the need for large amounts of loop diuretics, and TLV administration might prevent the induction of renal impairment by loop diuretics. 7,8) Worsening renal function in heart failure is a prognostic factor: We have often observed impaired renal function occurring during hospitalization in patients with acute HF, so called WRF. 9,10) A considerable number of patients admitted with ADHF have significant renal impairment, which influences treatment and outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…They also reported an add-on effect of TLV in patients with ADHF and renal dysfunction. 8) The TLV group showed more diuresis than the conventional group (6464.4 versus 4999.2 mL, P < 0.001) despite significantly lower loop diuretic doses (80 mg versus 120 mg, P < 0.001). However, the rate of WRF was not different between TLV and conventional groups (24.1% versus 27.8%, respectively; P = 0.642).…”

Section: And Prognosis In Acute Heart Failurementioning

confidence: 99%

Tolvaptan Improves Prognosis in Responders with Acute Decompensated Heart Failure by Reducing the Dose of Loop Diuretics

Sunagawa

Kinugawa

2018

Int. Heart J.

View full text Add to dashboard Cite

SummaryIt is unknown whether a response to tolvaptan (TLV) is related to prognosis in patients with acute decompensated heart failure (ADHF). We selected 25 patients as responders by their urinary response to TLV and by reduction of loop diuretics from 37 consecutive ADHF patients treated with TLV. As a control group, we selected 25 patients from 100 consecutive ADHF patients who were not treated with TLV by propensity score matching for age, serum sodium level, serum creatinine level, plasma B-type natriuretic peptide (BNP) level, systolic blood pressure, heart rate, and dose of loop diuretics. The primary outcome was defined as a composite endpoint of mortality and/or hemodialysis. The amount of loop diuretics administered to responders was reduced by TLV from 68.8 ± 26.2 mg to 30.4 ± 18.6 mg of furosemide equivalents per day, whereas the loop diuretic dose administered to non-responders was increased. The event-free survival of the TLV responders during 20 months was significantly better than that of the control group (95.8% versus 68.4%, P = 0.0406). The TLV responders, plasma BNP level, and estimated glomerular filtration rate were significantly related to the events in the Cox proportional hazard analysis. Patients with ADHF who respond to TLV may have a better prognosis than propensity-matched patients not receiving TLV treatment. In TLV responders, it may be possible to improve the patient's prognosis if the dose of loop diuretics can be reduced with TLV therapy.(Int Heart J 2018; 59: 87-93)

show abstract

“…Patients with worsening renal function are often encountered during the treatment of ADHF. Previous studies also reported that TLV alleviated renal dysfunction while treating ADHF, so TLV is a useful medication for treatment of patients with ADHF and renal dysfunction (2,13). In addition, serum sodium levels must be cautiously monitored because TLV was developed as a medication to treat hyponatremia (14).…”

Section: The Severity Of Heart Failure In Subjectsmentioning

confidence: 99%

Experience with long-term administration of tolvaptan to patients with acute decompensated heart failure

Kiuchi

Fujii

Hisatake

et al. 2017

DD&T

View full text Add to dashboard Cite

Clinical Effectiveness of Tolvaptan in Patients With Acute Heart Failure and Renal Dysfunction

Abstract: URL: http://www.umin.ac.jp/ctr/index/htm/ Unique identifier: UMIN000007109.

Cited by 105 publications

References 35 publications

Effects of Additive Tolvaptan vs. Increased Furosemide on Heart Failure With Diuretic Resistance and Renal Impairment　― Results From the K-STAR Study ―

Effects of Additive Tolvaptan vs. Increased Furosemide on Heart Failure With Diuretic Resistance and Renal Impairment　― Results From the K-STAR Study ―

Tolvaptan Improves Prognosis in Responders with Acute Decompensated Heart Failure by Reducing the Dose of Loop Diuretics

Experience with long-term administration of tolvaptan to patients with acute decompensated heart failure

Contact Info

Product

Resources

About

Clinical Effectiveness of Tolvaptan in Patients With Acute Heart Failure and Renal Dysfunction

Abstract: URL: http://www.umin.ac.jp/ctr/index/htm/ Unique identifier: UMIN000007109.

Cited by 105 publications

References 35 publications

Effects of Additive Tolvaptan vs. Increased Furosemide on Heart Failure With Diuretic Resistance and Renal Impairment ― Results From the K-STAR Study ―

Effects of Additive Tolvaptan vs. Increased Furosemide on Heart Failure With Diuretic Resistance and Renal Impairment ― Results From the K-STAR Study ―

Tolvaptan Improves Prognosis in Responders with Acute Decompensated Heart Failure by Reducing the Dose of Loop Diuretics

Experience with long-term administration of tolvaptan to patients with acute decompensated heart failure

Contact Info

Product

Resources

About

Effects of Additive Tolvaptan vs. Increased Furosemide on Heart Failure With Diuretic Resistance and Renal Impairment　― Results From the K-STAR Study ―

Effects of Additive Tolvaptan vs. Increased Furosemide on Heart Failure With Diuretic Resistance and Renal Impairment　― Results From the K-STAR Study ―