The efficacy of tolvaptan in the perioperative management of chronic kidney disease patients undergoing open-heart surgery

Yamada, Mitsutomo; Nishi, Hiroyuki; Sekiya, Naosumi; Horikawa, Kohei; Takahashi, Tetsuya; Sawa, Yoshiki

doi:10.1007/s00595-016-1406-5

Cited by 14 publications

(20 citation statements)

References 34 publications

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“…All studies that compared the difference between patients with tolvaptan and those without described that urine output in the tolvaptan group increased significantly compared to the nontolvaptan (control) group (Table 1) [36][37][38][39][40][41][42][43][44]. This effect seemed to occur around postoperative day 1-3 (Fig.…”

Section: Efficacy Of Tolvaptan After Surgerymentioning

confidence: 99%

Advent of New perioperative care for fluid management after cardiovascular surgery: A review of current evidence

Nishi

2020

Journal of Cardiology

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Section: Efficacy Of Tolvaptan After Surgerymentioning

confidence: 99%

Advent of New perioperative care for fluid management after cardiovascular surgery: A review of current evidence

Nishi

2020

Journal of Cardiology

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“…The authors of that study found tolvaptan to be an effective diuretic without causing electrolyte disbalance or worsening of renal function. Other published retrospective observational studies have also reported similar results (7)(8)(9). However, a significant limitation of observational studies is the high risk of bias.…”

Section: Efficacy Of Tolvaptan For Fluid Management After Cardiovascumentioning

confidence: 53%

“…Five were excluded as they were not RCTs ( 1 , 7 , 9 , 13 , 14 ). One study was conducted on pediatric patients ( 15 ), and another on patients with chronic kidney disease ( 8 ). Finally, four studies were included in this systematic review and meta-analysis ( 2 , 16-18 ).…”

Section: Resultsmentioning

confidence: 99%

“…On the other hand, tolvaptan has no influence on renal blood flow or GFR even in individuals with chronic kidney disease (30). One of the studies excluded from this review has demonstrated tolvaptan to be safe in chronic renal patients undergoing cardiac surgery (8). Similarly, studies on CHF patients have shown that tolvaptan prevents acute renal failure and reduces the amount of loop diuretic required for the management of such patients (31).…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of tolvaptan for fluid management after cardiovascular surgery: A systematic review and meta‑analysis of randomized control trials

Chen

Jiang

et al. 2020

Exp Ther Med

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The purpose of this study was to systematically search the literature and analyze evidence from randomized controlled trials (RCTs) comparing tolvaptan with conventional diuretics for postoperative fluid management in cardiac surgery patients. An electronic search of PubMed, Scopus, BioMed Central, CENTRAL (Cochrane Central Register of Controlled Trials) and Google scholar databases was carried out up to 1st December 2019. Four RCTs were included. Tolvaptan was co-administered with conventional diuretics in all the studies. The mean postoperative urine output was significantly greater in patients receiving tolvaptan as compared to controls (MD=0.39; 95% CI: 0.17 to 0.61; P=0.006, I 2 =48%). Body weight of patients on tolvaptan returned to pre-operative levels significantly earlier (MD=-1.57; 95% CI:-2.48 to-0.66; P=0.007, I 2 =50%). There was statistical significant difference in the highest postoperative serum sodium levels (MD=2.34; 95% CI:-1.65 to 3.03; p<0.00001, I 2 =0%), lowest serum sodium levels (MD=2.05; 95% CI: 1.41 to 2.68; p<0.00001, I 2 =0%) and mean serum sodium levels (MD=1.69; 95% CI: 0.98 to 2.40; p<0.00001, I 2 =0%) between the tolvaptan and control groups. Lowest serum potassium was significantly higher with tolvaptan as compared to the control group (MD=0.10; 95% CI: 0.01 to 0.18; P=0.03, I 2 =19%). There was no significant difference in the length of ICU stay or incidence of arrhythmias between the two groups. The quality of the included studies was not high. Within the limitations of our study, our results indicate that co-administration of tolvaptan with low dose of conventional diuretics significantly increases urine output while maintaining electrolyte balance in postoperative cardiac surgery patients. Faster return of body weight to pre-operative levels is evident with tolvaptan. Further high-quality RCTs are required to confirm this evidence.

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“…Little is known about the impact of tolvaptan in CKD patients in the perioperative management of open-heart surgery. 9) In the present study, the purpose was to retrospectively assess the efficacy of tolvaptan administration in CKD patients in the early postoperative period, following open-heart surgery.…”

Section: Introductionmentioning

confidence: 99%

The Efficacy and Renal Protective Effect of Tolvaptan in Chronic Kidney Disease Patients after Open-Heart Surgery

Futamura

Watanuki

Okada

et al. 2021

ATCS

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Purpose: Unlike loop diuretics, tolvaptan is reported to have a renal protective effect. The purpose of this study was to retrospectively assess the efficacy of tolvaptan administration in chronic kidney disease (CKD) patients following open-heart surgery. Methods: From February 2017 to August 2020, 75 patients with preoperative CKD stages IIIb-V were enrolled in this study and were divided into two groups: the control group (n = 30) and the tolvaptan group (n = 45). All patients routinely received conventional diuretics starting from postoperative day (POD) 1. Tolvaptan at 7.5-15 mg/day was administered if the patients had persistent fluid retention or poor response to conventional diuretics. Results: Tolvaptan administration was initiated at a mean of POD 2.9 ± 2.2, and the mean dosing period was 4.1 ± 3.0 days. The mean time to return to the preoperative body weight in the control and tolvaptan groups was similar. However, estimated glomerular filtration rate (eGFR) was significantly increased at the time when body weight reached the preoperative level and at discharge in the tolvaptan group than in the control group. Conclusion: This study demonstrated the renal protective effect of tolvaptan even in advanced CKD patients after open-heart surgery.

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The efficacy of tolvaptan in the perioperative management of chronic kidney disease patients undergoing open-heart surgery

Abstract: Tolvaptan can safely be used for CKD patients undergoing open-heart surgery and can provide a feasible urine volume without leading to a deterioration of their renal function.

Cited by 14 publications

References 34 publications

Advent of New perioperative care for fluid management after cardiovascular surgery: A review of current evidence

Advent of New perioperative care for fluid management after cardiovascular surgery: A review of current evidence

Efficacy of tolvaptan for fluid management after cardiovascular surgery: A systematic review and meta‑analysis of randomized control trials

The Efficacy and Renal Protective Effect of Tolvaptan in Chronic Kidney Disease Patients after Open-Heart Surgery

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