Tolvaptan, a Selective Oral Vasopressin V<sub>2</sub>-Receptor Antagonist, for Hyponatremia

Schrier, Robert W.; Groß, Peter; Gheorghiade, Mihai; Berl, Tomás; Verbalis, Joseph G.; Czerwiec, Frank S.; Orlandi, Cesare

doi:10.1056/nejmoa065181

Cited by 1,123 publications

(967 citation statements)

References 21 publications

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“…The variables entered in the univariate analysis included age, sex, ischaemic heart disease, LV end‐diastolic and end‐systolic diameters, LV ejection fraction, New York Heart Association functional class, previous episode of HF, systolic blood pressure, heart rate, hyponatraemia on admission, serum creatinine and BNP at discharge, and drug therapy over the clinical course. Hyponatraemia was defined as serum sodium level <135 mEq/L 13. Variables with P value <0.10 in univariate analysis, and those that had been demonstrated to be associated with all‐cause and cardiovascular mortality in HF patients by previous literature data were included in multivariate Cox proportional hazards models.…”

Section: Methodsmentioning

confidence: 99%

The association between high‐dose loop diuretic use at discharge and cardiovascular mortality in patients with heart failure

et al. 2017

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AimsFew studies have reported the impact of high‐dose loop diuretics at discharge on prognosis in Japanese patients with heart failure (HF). Our purpose was to assess the relationship between the dose of loop diuretics at discharge and cardiovascular mortality in patients with HF.Methods and resultsWe enrolled decompensated HF patients who were admitted to our hospital between March 2010 and March 2015, and compared HF patients who received high‐dose loop diuretics at discharge (HD group) with low‐dose loop diuretics at discharge (LD group) with regard to risk of cardiovascular mortality, and all‐cause mortality. High‐dose loop diuretic was defined as ≥40 mg/day of oral furosemide at discharge. A total of 215 patients were enrolled to the study. The median follow‐up duration was 641 days. All‐cause and cardiovascular mortality were significantly lower in the LD group than in the HD group (10.4% vs. 31.6%, P < 0.001; 2.2% vs. 24.6%, P < 0.001, respectively). High‐dose loop diuretics were associated with cardiovascular mortality in multivariate Cox proportional hazards model (hazard ratio, 16.06, 95% confidence interval 3.457 to 116.8; P < 0.001). The largest area under the receiver operating characteristic curve (0.85) for cardiovascular death was obtained with a threshold of 40 mg furosemide.ConclusionsHigh‐dose loop diuretic use at discharge was one of the predictors of cardiovascular mortality in patients with HF. An oral furosemide dose of 40 mg daily may be defined as ‘high‐dose’ loop diuretics in Japanese patients with chronic HF.

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Section: Methodsmentioning

confidence: 99%

The association between high‐dose loop diuretic use at discharge and cardiovascular mortality in patients with heart failure

et al. 2017

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“…This is an attractive therapeutic avenue because it tackles the cause of the underlying fluid retention 11.…”

Section: Treatment Of Hyponatraemiamentioning

confidence: 99%

“…The SALT‐1 and SALT‐2 trials have shown that serum sodium can be safely improved in patients with hyponatraemia through removal of excess free water, producing additional benefits in patients’ quality of life, as measured by 12‐item Short Form General Health Survey scores 11. The prompt correction of hyponatraemia in patients with SIADH may be associated with a reduction in hospital stay 12.…”

Section: Treatment Of Hyponatraemiamentioning

confidence: 99%

The diagnosis and management of inpatient hyponatraemia and SIADH

Grant

Ayuk

Bouloux

et al. 2015

Eur J Clin Investigation

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BackgroundHyponatraemia is a very common medical condition that is associated with multiple poor clinical outcomes and is often managed suboptimally because of inadequate assessment and investigation. Previously published guidelines for its management are often complex and impractical to follow in a hospital environment, where patients may present to divergent specialists, as well as to generalists.DesignA group of senior, experienced UK clinicians, met to develop a practical algorithm for the assessment and management of hyponatraemia in a hospital setting. The latest evidence was discussed and reviewed in the light of current clinical practicalities to ensure an up‐to‐date perspective. An algorithm was largely developed following consensus opinion, followed up with subsequent additions and amendments that were agreed by all authors during several rounds of review.ResultsWe present a practical algorithm which includes a breakdown of the best methods to evaluate volume status, simple assessments for the diagnosis of the various causes and a straightforward approach to treatment to minimise complexity and maximise patient safety.ConclusionThe algorithm we have developed reflects the best available evidence and extensive clinical experience and provides practical, useable guidance to improve patient care.

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“…Vasopressin receptor antagonists correct symptomatic dilutional hyponatremia resistant to conservative measures. 49 However, tolvaptan use in patients with cirrhosis has been the subject of an US Food and Drug Administration warning because of rare hepatotoxicity. Tolvaptan use is no longer endorsed by the US Food and Drug Administration, but it remains an effective means of hyponatremia treatment when other therapeutic measures fail and the risks have been considered.…”

Section: Hyponatremiamentioning

confidence: 99%

Keeping high model for end‐stage liver disease score liver transplantation candidates alive

et al. 2015

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Tolvaptan, a Selective Oral Vasopressin V₂-Receptor Antagonist, for Hyponatremia

Cited by 1,123 publications

References 21 publications

The association between high‐dose loop diuretic use at discharge and cardiovascular mortality in patients with heart failure

The association between high‐dose loop diuretic use at discharge and cardiovascular mortality in patients with heart failure

The diagnosis and management of inpatient hyponatraemia and SIADH

Keeping high model for end‐stage liver disease score liver transplantation candidates alive

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Tolvaptan, a Selective Oral Vasopressin V2-Receptor Antagonist, for Hyponatremia

Cited by 1,123 publications

References 21 publications

The association between high‐dose loop diuretic use at discharge and cardiovascular mortality in patients with heart failure

The association between high‐dose loop diuretic use at discharge and cardiovascular mortality in patients with heart failure

The diagnosis and management of inpatient hyponatraemia and SIADH

Keeping high model for end‐stage liver disease score liver transplantation candidates alive

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Product

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Tolvaptan, a Selective Oral Vasopressin V₂-Receptor Antagonist, for Hyponatremia