Clinical benefit of tolvaptan in patients with acute decompensated heart failure and chronic kidney disease

Uemura, Yoshiko; Shibata, Rei; Takemoto, Kenji; Uchikawa, Tomohiro; Koyasu, Masayoshi; Ishikawa, Shinya; Mitsuda, Takayuki; Miura, Ayako; Imai, Ryo; Iwamiya, Satoshi; Ozaki, Yuta; Kato, Tomohiro; Miura, Takanori; Watarai, Masato; Murohara, Toyoaki

doi:10.1007/s00380-015-0775-9

Cited by 36 publications

(23 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There was no report that tolvaptan was associated with longer survival time in patients with heart failure [19][20]. On the other hand, some reports showed that tolvaptan responders were associated with longer survival time in cirrhotic patients [8,[21][22][23].…”

Section: Discussionmentioning

confidence: 91%

Positive Response to Tolvaptan Treatment Would Be a Good Prognostic Factor for Cirrhotic Patients with Ascites

Kida¹

2019

Dig Dis

View full text Add to dashboard Cite

Aims: Ascites is one of the major complications in advanced cirrhotic patients. Tolvaptan is a non-peptide orally available arginine vasopressin V2 receptor antagonist. We investigated and found that tolvaptan therapy improved the prognosis and predictive factor of cirrhotic patients with ascites. Methods: Overall, 99 patients with newly diagnosed ascites with cirrhosis were enrolled. No patients had intrahepatic malignancy. The patients were divided into 2 groups based on tolvaptan therapy: 86 patients treated with tolvaptan (tolvaptan-group) and 13 patients treated without tolvaptan (non-tolvaptan-group). Tolvaptan-responder was defined as body weight loss of ≥1.5 kg/week after administering tolvaptan. Results: Tolvaptan therapy was effective in 61.6% of cirrhotic patients. There was a significant difference in the overall survival (OS) between the tolvaptan-responder-group and the other groups (p < 0.001). Male (HR 5.05; p = 0.01), tolvaptan responder (HR 0.21; p = 0.02), and dosage of furosemide < 40 mg/day (HR 0.17; p = 0.01) were factors that were independently associated with the OS. The multivariate analysis revealed that C-reactive protein < 0.9 mg/dL (HR 0.07; p = 0.001), and furosemide dosage < 40 mg/day (HR 0.09; p = 0.003) were independently associated with the tolvaptan response. Conclusion: Therapeutic response to tolvaptan was associated with longer survival in cirrhosis patients complicated with ascites. These preliminary findings warrant validation and further exploration.

show abstract

Section: Discussionmentioning

confidence: 91%

Positive Response to Tolvaptan Treatment Would Be a Good Prognostic Factor for Cirrhotic Patients with Ascites

Kida¹

2019

Dig Dis

View full text Add to dashboard Cite

show abstract

“…Uemura, et al retrospectively evaluated the change in creatinine and rehospitalization up to 6 months after discharge, and concluded TLV prevented increase of creatinine and rehospitalization. 22) The present study showed continuous TLV administration (average administration period: 347 ± 212 days) could prevent medium-term WRF and decrease its associated long-term adverse outcomes. Therefore, together with findings from previous studies, TLV might be an effective therapy to improve medium-term clinical outcomes as well as long-term outcomes.…”

Section: Discussionmentioning

confidence: 95%

Impact of Continuous Administration of Tolvaptan on Preventing Medium-Term Worsening Renal Function and Long-Term Adverse Events in Heart Failure Patients with Chronic Kidney Disease

et al. 2018

View full text Add to dashboard Cite

SummaryTolvaptan (TLV) has an inhibiting effect for worsening renal function (WRF) in acute decompensated heart failure (HF) patients. However, there are limited data regarding the effect of continuous TLV administration on medium-term WRF.This was a retrospective observational study in hospitalized HF patients with chronic kidney disease (CKD). TLV was administered to those patients with fluid retention despite standard HF therapy. We compared 34 patients treated with TLV (TLV group) to 33 patients treated with conventional HF therapy with high-dose loop diuretics (furosemide !40 mg) (Loop group). Clinical outcomes, including the incidence of medium-term WRF, defined as increase of serum creatinine > 0.3 mg/dL, at 6 months after discharge and adverse events rate, were evaluated.Baseline patient characteristics were not different between the TLV and Loop group. The TLV group consisted of less frequent use of loop diuretics and carperitide compared with the Loop group. The incidence of medium-term WRF was significantly lower in the TLV group than in the Loop group (3.2% versus 31.0%, P = 0.002). Multivariate logistic analysis showed that the TLV non-user was an independent predictor of mediumterm WRF. Kaplan-Meier analysis revealed that the long-term event-free survival was significantly higher in the TLV group (log-rank P = 0.01).Continuous administration of TLV may reduce the risk of medium-term WRF, resulting possibility in improvement of long-term adverse outcomes in HF patients with CKD.(Int Heart J 2018; 59: 105-111)

show abstract

“…10 Tolvaptan alleviates volume status and clinical symptoms in patients with congestive heart failure, [11][12][13][14][15] although the clinical outcomes in heart failure patients (mostly without diabetes) with renal insufficiency were inconsistent. [16][17][18] Patients with heart failure who were nonresponsive to tolvaptan were shown to have higher serum creatinine levels. 19 Additionally, decreased renal function attenuates tolvaptan-induced free water clearance.…”

mentioning

confidence: 99%

Tolvaptan alleviates excessive fluid retention of nephrotic diabetic renal failure unresponsive to furosemide

et al. 2018

View full text Add to dashboard Cite

Patients with diabetic nephropathy develop nephrotic syndrome and may show limited response to conventional therapy. They often require earlier initiation of renal replacement therapy because they become refractory to diuretics, and experience excessive fluid retention. We aimed to investigate the efficacy of tolvaptan, an oral arginine vasopressin type 2 receptor antagonist, in a case series of 14 severe diabetic renal failure patients who were severely refractory to maximal doses of furosemide and had excessive fluid retention despite preserved cardiac function and residual renal function. All 14 patients experienced immediate and sustained water diuretic effects, resulting in alleviation of congestive heart failure. None required initiation of renal replacement therapy. Tolvaptan promptly increased urine volume and free water clearance, reversed progressive fluid retention, and alleviated congestive heart failure. Thus, tolvaptan could serve as a potential adjunct therapy for severe diabetic renal failure patients with excessive fluid retention and congestive heart failure.

show abstract

Clinical benefit of tolvaptan in patients with acute decompensated heart failure and chronic kidney disease

Cited by 36 publications

References 30 publications

Positive Response to Tolvaptan Treatment Would Be a Good Prognostic Factor for Cirrhotic Patients with Ascites

Positive Response to Tolvaptan Treatment Would Be a Good Prognostic Factor for Cirrhotic Patients with Ascites

Impact of Continuous Administration of Tolvaptan on Preventing Medium-Term Worsening Renal Function and Long-Term Adverse Events in Heart Failure Patients with Chronic Kidney Disease

Tolvaptan alleviates excessive fluid retention of nephrotic diabetic renal failure unresponsive to furosemide

Contact Info

Product

Resources

About