Novel Criteria of Urine Osmolality Effectively Predict Response to Tolvaptan in Decompensated Heart Failure Patients

Imamura, Teruhiko; Kinugawa, Koichiro; Shiga, Taro; Kato, Naoko; Muraoka, Hironori; Minatsuki, Shun; Inaba, Toshiro; Maki, Hisataka; Hatano, Masaru; Yao, Atsushi; Kyo, Shunei; Nagai, Ryozo

doi:10.1253/circj.cj-12-0971

Cited by 114 publications

(130 citation statements)

References 28 publications

Supporting

Mentioning

115

Contrasting

Unclassified

Order By: Relevance

“…U-AQP2 and responsiveness to TLV: We previously demonstrated that responsiveness to TLV is largely dependent on the viability of the collecting duct, 11) and that TLV-responders can be discriminated from TLV-non-responders by measuring their respective baseline U-AQP2 relative to P-AVP level prior to TLV administration. 12) However, few reports exist on the concentration-time profile of U-AQP2 after the initiation of TLV therapy.…”

Section: 23)mentioning

confidence: 99%

“…This result supports our hypothesis that the unresponsiveness to TLV was not attributable to the low blood concentration of TLV due to malabsorption, but rather to the dysfunction of the renal collecting duct. 11,12) Accordingly, the up-titration of TLV may not be effective in the TLV-non-responders. We previously proposed the criterion to predict responsiveness to TLV: the U-AQP2 level relative to the P-AVP level, which can be obtained before the initiation of TLV therapy.…”

Section: )mentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10] In contrast, we sometimes experience TLV-non-responders in our daily clinical practice. 11) We previously proposed a novel predictor of responsiveness to TLV, ie, the baseline urine aquaporin-2 (U-AQP2) level relative to the plasma AVP (P-AVP) level, which may indicate a preserved vasopressin type 2 receptor (V2R)-related signaling pathway in the principal cells of the renal collecting duct. 12,13) However, little is known about the concentration-time profile of U-AQP2 after the initiation of TLV treatment.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Tolvaptan Prolongs Blockage of the Vasopressin Type II Receptor Over 24 Hours in Responders With Stage D Heart Failure

2016

Self Cite

View full text Add to dashboard Cite

SummaryThe urine aquaporin-2 (U-AQP2) level relative to the plasma arginine vasopressin (P-AVP) level is a novel predictor of the responsiveness to the vasopressin type 2 receptor (V2R) antagonist tolvaptan (TLV). However, little has been reported about the concentration-time profile of U-AQP2 after TLV treatment. We evaluated 24 patients with decompensated stage D heart failure (HF) who had received 3.75 mg/day of TLV on a de novo basis for > 7 days to treat congestion refractory to conventional diuretics. Seventeen patients were TLV-responders, whose 24-hour urine volume (UV) increased after TLV initiation; the other 7 patients were TLV-non-responders. The U-AQP2 of the TLV-responders, corrected for the urine creatinine concentration, decreased significantly at 4 hours after TLV administration without returning to the day-1 morning level on the morning of day-7. The TLV-non-responder U-AQP2 levels remained low even before the TLV treatment. On the morning of day-7, the TLV-responder U-AQP2/P-AVP ratio was comparable to that of the TLV-non-responders. Among 18 patients (11 responders and 7 non-responders), the day-7 TLV trough concentration was 64 ± 62 ng/mL and was negatively correlated with the estimated glomerular filtration rate (eGFR). TLV has antagonistic effects on the V2R over 24 hours in TLV-responders with advanced heart failure and chronic kidney disease, probably due to persistently elevated blood TLV concentration. The unresponsiveness to TLV in the TLV-non-responders is not attributable to malabsorption. (Int Heart J 2016; 57: 41-46)

show abstract

Section: 23)mentioning

confidence: 99%

Section: )mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Tolvaptan Prolongs Blockage of the Vasopressin Type II Receptor Over 24 Hours in Responders With Stage D Heart Failure

2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4][5][6][7][8][9] High age and chronic kidney disease are known risk factors of refractoriness to TLV, [10][11][12] whereas preserved function of the renal collecting duct, which is confirmed by a higher level of urine aquaporin-2 (U-AQP2) relative to plasma AVP (P-AVP), is a predictor of responses to TLV. 13) Responders seem to experience not only an improved clinical course but also better prognosis during TLV treatment compared with those not receiving TLV.…”

mentioning

confidence: 99%

Tolvaptan Improves the Long-Term Prognosis in Patients With Congestive Heart Failure With Preserved Ejection Fraction as Well as in Those With Reduced Ejection Fraction

Imamura

Kinugawa

2016

Int. Heart J.

Self Cite

View full text Add to dashboard Cite

SummaryTolvaptan (TLV), an arginine vasopressin type 2 antagonist, has been shown to play a role in ameliorating symptomatic congestion and normalizing diluted hyponatremia in patients with congestive heart failure (HF). However, most evidence was derived from patients with HF with reduced ejection fraction (HFrEF), and the clinical efficacy of TLV in patients with HF with preserved ejection fraction (HFpEF) remains uncertain. In this study, we retrospectively enrolled 60 in-hospital patients with stage D HF, who had received TLV to treat symptomatic congestion at our institute between 2011 and 2013. As a control group, we also enrolled 60 background-matched HF patients who did not receive TLV therapy. Patients with HFpEF (n = 29), whose left ventricular ejection fraction was > 45%, had higher age and a lower urine aquaporin-2 level relative to the plasma arginine vasopressin concentration compared with those with HFrEF (n = 91). TLV therapy significantly reduced the 2-year readmission rates in both the HFrEF and HFpEF populations (P < 0.05 for both), indicating that TLV therapy may improve the long-term prognosis not only in patients with HFrEF but also in those with HFpEF. (Int Heart J 2016; 57: 600-606)

show abstract

“…In addition, Imamura, et al reported that elderly patients were significantly resistant to tolvaptan treatment compared with younger patients, although the number of study subjects was too small. 13) Therefore, the safety and efficiency of tolvaptan in elderly patients remain controversial.…”

Section: Article P137mentioning

confidence: 99%

Octogenarian Patients With Heart Failure

Yamamoto

2015

Int. Heart J.

View full text Add to dashboard Cite

Novel Criteria of Urine Osmolality Effectively Predict Response to Tolvaptan in Decompensated Heart Failure Patients

Cited by 114 publications

References 28 publications

Tolvaptan Prolongs Blockage of the Vasopressin Type II Receptor Over 24 Hours in Responders With Stage D Heart Failure

Tolvaptan Prolongs Blockage of the Vasopressin Type II Receptor Over 24 Hours in Responders With Stage D Heart Failure

Tolvaptan Improves the Long-Term Prognosis in Patients With Congestive Heart Failure With Preserved Ejection Fraction as Well as in Those With Reduced Ejection Fraction

Octogenarian Patients With Heart Failure

Contact Info

Product

Resources

About