Urine Osmolality-Guided Tolvaptan Therapy in Decompensated Heart Failure

Dohi, Kaoru; Watanabe, Kiyotaka; M, Ito

doi:10.1253/circj.cj-12-1535

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…Mean body weight was also decreased at 7 th day from the baseline, but this finding was not statistically significant like previous study. Similar to previous studies,[19] our patients significantly became asymptomatic after starting of tolvaptan.…”

Section: Discussionsupporting

confidence: 91%

Short term efficacy and safety of low dose tolvaptan in patients with acute decompensated heart failure with hyponatremia: a prospective observational pilot study from a single center in South India

et al. 2014

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Background:In acute decompensated heart failure (ADHF), diuretic use, the mainstay therapy for congestion, is associated with electrolyte abnormalities and worsening renal function. Vasopressin mediates fluid retention in heart failure. In contrast to diuretics, the vasopressin antagonist tolvaptan may increase net volume loss in heart failure without adversely affecting electrolytes and renal function. Hyponatremia (serum sodium concentration, <135 mEq/L) is a predictor of death among patients with heart failure.Objective:We prospectively observed the short term efficacy and safety of low dose (15 mg) tolvaptan in admitted patients with hyponatremia and ADHF in Indian population.Methodology:A total of 40 patients with ADHF along with hyponatremia (<125 mEq/L) on standard therapy were treated with 15 mg of tolvaptan at a single oral dose for 7 days.Results:Serum sodium concentrations increased significantly after treatment with tolvaptan from baseline (P < 0.02). There was a significant improvement in symptoms and New York Heart Association (NYHA) class after starting tolvaptan (P ≤ 0.05). Total diuretic dose and mean body weight was reduced non-significantly at 7th day from the baseline. Side-effects associated with tolvaptan included increased thirst, dry mouth and increased urination. Few patients had worsening renal function. However, several patients developed hypernatremia.Conclusion:In this small observational study, tolvaptan initiation in patients with ADHF with hyponatremia in addition to standard therapy may hold promise in improvement in NYHA class and serum sodium. At the same time, we observed that serious adverse events such as renal function deterioration and hypernatremia developed after tolvaptan treatment, which needs to be addressed in future by randomized study with larger sample size.

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Section: Discussionsupporting

confidence: 91%

Short term efficacy and safety of low dose tolvaptan in patients with acute decompensated heart failure with hyponatremia: a prospective observational pilot study from a single center in South India

et al. 2014

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“…3,4) In particular, there have been a number of case reports for treating fluid retention in congestive heart failure where there is insufficient response to treatment using existing diuretics such as furosemide. 5) Tolvaptan is a new water diuretic that inhibits water reabsorption in the kidney collecting ducts and elicits a diuretic effect without electrolyte output.…”

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confidence: 99%

Effect of Tolvaptan in Patients With Chronic Kidney Disease Due to Diabetic Nephropathy With Heart Failure

et al. 2014

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SummaryThe efficacy of tolvaptan for treating heart failure has already been shown. Adequate data relating to the effect of tolvaptan on the correlation of water balance in renal disease are not available. A retrospective study was conducted on the efficacy and adverse reactions of tolvaptan for treating nephrotic syndrome.The subjects were 26 patients with chronic kidney failure due to diabetic nephropathy with heart failure who were administered tolvaptan and seen between December 2011 and October 2013. The endpoints were urinary output, physical findings, and blood analyses. The expression of aquaporin-2 in the collecting duct, which is related to the action of tolvaptan, was investigated by immunohistochemistry using the kidney tissue obtained for the diagnosis.Responses were seen in 19 of the patients. In the histopathological investigation there was severe glomerulosclerosis in patients with diabetic nephropathy, but the responders were noticeable in that they only had mild tubulointerstitial damage. Non-responders exhibited profound tubulointerstitial damage. The expression of aquaporin-2 was determined in 8 patients, of which 7 were responders who tested positive for aquaporin-2. The remaining case was a non-responder who showed no expression of aquaporin-2.Tolvaptan is considered effective for some cases of nephrotic syndrome. There are no clear parameters for predicting an effect, but the present study showed that aquaporin-2 was expressed in the epithelial cells of the collecting ducts of tolvaptan responders. (Int Heart J 2014; 55: 533-538)

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“…The vasopressin type 2 receptor (V2R) stimulated by AVP induces free water reabsorption via aquaporin-2 in the renal collecting duct, 8, 9 and therefore selective V2R antagonist produces aquaresis that leads to clinical improvement in heart failure symptoms. 10, 11 Recent experimental studies demonstrated that long-term administration of selective V2R antagonism has favorable effects on cardiac hemodynamics, and ameliorates LV remodeling and myocardial fibrosis in concert with diuretic…”

Section: Methodsmentioning

confidence: 99%

Detrimental Impact of Vasopressin V2 Receptor Antagonism in a SU5416/Hypoxia/Normoxia-Exposed Rat Model of Pulmonary Arterial Hypertension

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Ogihara

et al. 2016

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Urine Osmolality-Guided Tolvaptan Therapy in Decompensated Heart Failure

Cited by 5 publications

References 10 publications

Short term efficacy and safety of low dose tolvaptan in patients with acute decompensated heart failure with hyponatremia: a prospective observational pilot study from a single center in South India

Short term efficacy and safety of low dose tolvaptan in patients with acute decompensated heart failure with hyponatremia: a prospective observational pilot study from a single center in South India

Effect of Tolvaptan in Patients With Chronic Kidney Disease Due to Diabetic Nephropathy With Heart Failure

Detrimental Impact of Vasopressin V2 Receptor Antagonism in a SU5416/Hypoxia/Normoxia-Exposed Rat Model of Pulmonary Arterial Hypertension

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