Tolvaptan reduces the risk of worsening renal function in patients with acute decompensated heart failure in high-risk population

Matsue, Yuya; Suzuki, Makoto; Seya, Mie; Iwatsuka, Ryota; Mizukami, Akira; Nagahori, Wataru; Ohno, Masakazu; Matsumura, Akihiko; Hashimoto, Yuji

doi:10.1016/j.jjcc.2012.08.020

Cited by 84 publications

(72 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Propensity score matching analyses: The clinical use of TLV has increased recently, and many authors have showed that TLV is beneficial in ameliorating symptomatic congestion and in normalizing hyponatremia, thus improving renal function in patients with decompensated HF. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Therefore, prospective recruitment of a control group has thus far been ethically difficult considering the obvious clinical advantage of TLV treatment.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14] Although the long-term efficacy of TLV remains controversial, 6) we recently demonstrated the benefits of long-term administration of TLV on survival and re-admission, especially in responders to TLV. 15) Despite its clinical advantage, TLV is expensive compared with other conventional diuretics, which is an important limitation considering current increases in total medical expenses.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Tolvaptan Reduces Long-Term Total Medical Expenses and Length of Stay in Aquaporin-Defined Responders

et al. 2016

View full text Add to dashboard Cite

SummaryThe vasopressin type-2 antagonist tolvaptan (TLV) has clinical advantages including amelioration of congestion and normalization of hyponatremia in patients with decompensated heart failure (HF). However, there have been no studies on the cost-effectiveness of TLV therapy. We enrolled 60 consecutive hospitalized patients with stage D HF who received TLV [TLV (+) group], and 60 propensity score-matched HF patients without TLV treatment [TLV (-) group]. We excluded 54 patients who died or received cardiac replacement therapy within 1 year, and finally enrolled 32 patients who received TLV and 34 who did not, who were followed for > 1 year. Among 45 aquaporin-defined responders, whose urine aquaporin-2 relative to plasma arginine vasopressin level was > 1.4 × 10 3 L/g Cre, the TLV (+) group required significantly lower total medical expenses and shorter lengths of stay (LOS) In contrast, among the remaining 21 aquaporin-defined non-responders, medical expenses and LOS were comparable irrespective of TLV administration (P = 0.087 and P = 0.407). In conclusion, TLV therapy may reduce total medical expenses in aquaporin-defined responders with stage D HF. (Int Heart J 2016; 57: 593-599)

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Tolvaptan Reduces Long-Term Total Medical Expenses and Length of Stay in Aquaporin-Defined Responders

et al. 2016

View full text Add to dashboard Cite

show abstract

“…34 Several studies reported on the effectiveness of the combined use of tolvaptan and furosemide in HF patients with renal dysfunction. 35, 36 Thus, tolvaptan may have beneficial effects in HF patients with reduced eGFR who need high-dose loop diuretics.…”

Section: Combination Of Raas Inhibitors and β-Blockers With Loop Diurmentioning

confidence: 99%

Prognostic Impact of Loop Diuretics in Patients With Chronic Heart Failure　– Effects of Addition of Renin-Angiotensin-Aldosterone System Inhibitors and β-Blockers –

Miura

Sugimura

Sakata

et al. 2016

Circ J

View full text Add to dashboard Cite

on behalf of the CHART-2 InvestigatorsBackground: It remains to be elucidated whether addition of renin-angiotensin-aldosterone system (RAAS) inhibitors and/or β-blockers to loop diuretics has a beneficial prognostic impact on chronic heart failure (CHF) patients. Methods and Results:From the Chronic Heart failure Analysis and Registry in the Tohoku district 2 (CHART-2) Study (n=10,219), we enrolled 4,134 consecutive patients with symptomatic stage C/D CHF (mean age, 69.3 years, 67.7% male). We constructed Cox models for composite of death, myocardial infarction, stroke and HF admission. On multivariate inverse probability of treatment weighted (IPTW) Cox modeling, loop diuretics use was associated with worse prognosis with hazard ratio (HR) 1.28 (P<0001). Furthermore, on IPTW multivariate Cox modeling for multiple treatments, both low-dose (<40 mg/day) and high-dose (≥40 mg/day) loop diuretics were associated with worse prognosis with HR 1.32 and 1.56, respectively (both P<0.001). Triple blockade with RAS inhibitor(s), mineral corticoid (aldosterone) receptor antagonist(s) (MRA), and β-blocker(s) was significantly associated with better prognosis in those on low-dose but not on high-dose loop diuretics. Conclusions:Chronic use of loop diuretics is significantly associated with worse prognosis in CHF patients in a dose-dependent manner, whereas the triple combination of RAAS inhibitor(s), MRA, and β-blocker(s) is associated with better prognosis when combined with low-dose loop diuretics. (Circ J 2016; 80: 1396 -1403

show abstract

“…24 A recent small study in patients with AHF and low baseline GFR showed that tolvaptan, when added to furosemide, was associated with superior decongestion and considerably less WRF with lower doses of furosemide. 26 In the EVEREST trial, patients randomized to tolvaptan also were given lower doses of furosemide, despite persistent lower body weight, 24 stable renal function, and no other safety concerns. The available clinical data along with the mechanistic issues, therefore, suggest that a larger, longer term trial of this drug in patients with AHF and WRF would be feasible at this time.…”

Section: Circ Heart Failmentioning

confidence: 99%

Decongestive Therapy and Renal Function in Acute Heart Failure

Goldsmith

Bart

Burnett

2014

Circ: Heart Failure

View full text Add to dashboard Cite

Tolvaptan reduces the risk of worsening renal function in patients with acute decompensated heart failure in high-risk population

Abstract: In patients with ADHF with high risk of WRF, treatment with tolvaptan could prevent WRF compared to conventional therapy.

Cited by 84 publications

References 38 publications

Tolvaptan Reduces Long-Term Total Medical Expenses and Length of Stay in Aquaporin-Defined Responders

Tolvaptan Reduces Long-Term Total Medical Expenses and Length of Stay in Aquaporin-Defined Responders

Prognostic Impact of Loop Diuretics in Patients With Chronic Heart Failure　– Effects of Addition of Renin-Angiotensin-Aldosterone System Inhibitors and β-Blockers –

Decongestive Therapy and Renal Function in Acute Heart Failure

Contact Info

Product

Resources

About

Tolvaptan reduces the risk of worsening renal function in patients with acute decompensated heart failure in high-risk population

Abstract: In patients with ADHF with high risk of WRF, treatment with tolvaptan could prevent WRF compared to conventional therapy.

Cited by 84 publications

References 38 publications

Tolvaptan Reduces Long-Term Total Medical Expenses and Length of Stay in Aquaporin-Defined Responders

Tolvaptan Reduces Long-Term Total Medical Expenses and Length of Stay in Aquaporin-Defined Responders

Prognostic Impact of Loop Diuretics in Patients With Chronic Heart Failure – Effects of Addition of Renin-Angiotensin-Aldosterone System Inhibitors and β-Blockers –

Decongestive Therapy and Renal Function in Acute Heart Failure

Contact Info

Product

Resources

About

Prognostic Impact of Loop Diuretics in Patients With Chronic Heart Failure　– Effects of Addition of Renin-Angiotensin-Aldosterone System Inhibitors and β-Blockers –