Early administration of tolvaptan preserves renal function in elderly patients with acute decompensated heart failure

Kimura, Kazuhiro; Momose, Tomoyasu; Hasegawa, Tomoya; Morita, Takehiro; Misawa, Takuo; Motoki, Hirohiko; Izawa, Atsushi; Ikeda, Uichi

doi:10.1016/j.jjcc.2015.09.020

Cited by 62 publications

(68 citation statements)

References 31 publications

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“…Previous studies of TLV use were tested in acute HF without accounting for diuretic resistance. [8][9][10][11] There are 3 main findings of the present study. First, additive TLV resulted in significantly higher UV than increased FUR, primarily through increased urinary water excretion in HF patients with residual congestion despite concomitant FUR.…”

Section: Discussionmentioning

confidence: 51%

“…31 Regrettably, we could not determine whether the occurrence of WRF was transient or persistent, because the study design only included data collected during treatment for 7 days. 11 We used simple treatments to add a relatively low dose of TLV or FUR to standard therapy, representing residual congestion to be continued in 10-20% of subjects ( Figure 3B). Although the recent clinical trial of TLV in Japan has set comparative doses of increased FUR and additive TLV that resemble those used in the present study, 9 the clinical figures after the treatments provided in the present study underscore the ongoing unmet need to develop better strategies for aggressive decongestion in diuretic-resistant HF patients.…”

Section: Study Limitations and Future Prospectsmentioning

confidence: 99%

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Effects of Additive Tolvaptan vs. Increased Furosemide on Heart Failure With Diuretic Resistance and Renal Impairment　― Results From the K-STAR Study ―

Inomata

Ikeda

Kida

et al. 2018

Circ J

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Background: Although diuretic resistance leading to residual congestion is a known predictor of a poorer heart failure (HF) prognosis, better therapeutic strategies for effective and safe decongestion have not been established. Methods and Results:In this study, 81 HF patients with fluid retention (despite taking ≥40 mg/day furosemide (FUR)), with an estimated glomerular filtration rate <45 mL/min/1.73 m 2 , were randomized into 2 groups and administered either ≤15 mg/day additive tolvaptan (TLV) or ≤40 mg/day increased FUR for 7 days. Changes in urine volume between baseline and mean urine volume during treatment were significantly higher in the TLV than FUR group (P=0.0003). Although there was no significant decrease in body weight or improved signs and symptoms of congestion between the 2 groups, the increase in serum creatinine on Day 7 from baseline was significantly smaller in the TLV than FUR group (P=0.038). Multiple logistic regression analysis revealed that additive TLV (odds ratio 0.157, 95% confidence interval 0.043-0.605, P=0.001) was an independent clinical factor for improved renal function during treatment compared with increased FUR. Conclusions:In HF patients with residual congestion and renal dysfunction refractory to standard therapy, additive TLV increased urine volume without further renal impairment compared with patients who received an increased dose of FUR.

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Section: Discussionmentioning

confidence: 51%

Section: Study Limitations and Future Prospectsmentioning

confidence: 99%

Effects of Additive Tolvaptan vs. Increased Furosemide on Heart Failure With Diuretic Resistance and Renal Impairment　― Results From the K-STAR Study ―

Inomata

Ikeda

Kida

et al. 2018

Circ J

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“…12) Recently, several studies showed TLV was effective to maintain renal function in ADHF patients. 13,14) However, there are limited data regarding the effect of continuous use of TLV on medium-term WRF.…”

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confidence: 99%

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

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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)

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“…In some studies, favorable effects for renal function of tolvaptan, unlike loop diuretics, have been reported in both in vitro and in vivo investigations. 25,26) Compared with furosemide, tolvaptan induced Changes of blood pressure and heart rate after TLV treatment. During the first 3 days, systolic and diastolic blood pressures at every 8 hours were relatively stable, whereas patients experienced increased heart rate after TLV treatment.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Congestive Heart Failure Due to Severe Aortic Valve Stenosis With Low Dose Tolvaptan in Elderly Patients

et al. 2017

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SummaryMedical therapy for severe aortic valve stenosis (AS) is necessary for inoperable patients due to comorbid conditions. Tolvaptan (TLV), unlike other diuretics, resulted in modest changes in filling pressures associated with an increase in urine output, suggesting that TLV improves congestive heart failure (CHF) due to severe AS without hemodynamic instability.We retrospectively investigated 14 consecutive patients ≥ 80 years of age admitted due to decompensated CHF with severe AS at Juntendo University Hospital from April 2014 to November 2015. Seven of the 14 patients were treated with TLV. We examined the safety and efficacy of TLV treatment for severe AS.Mean age was 90.0 ± 6.3 years and mean aortic valve area was 0.57 ± 0.22 cm 2. Urine volume at day 1 of TLV treatment was increased and urine osmolality significantly decreased at day 1 of TLV treatment (all P < 0.05). New York Heart Association classification and brain natriuretic peptide levels significantly improved 1 week after treatment and at discharge (all P < 0.05) whereas brain natriuretic peptide levels did not improve in the patients without TLV. Severe adverse events did not occur during TLV treatment. During the first 3 days, blood pressure and heart rate were relatively stable. TLV treatment did not affect serum creatinine, blood urea nitrogen, or the estimated glomerular filtration rate.In elderly patients with severe AS, TLV treatment improved CHF without hemodynamic instability. Further prospective studies are needed to assess the safety and efficacy of TLV in decompensated heart failure due to severe AS. (Int Heart J 2017; 58: 378-384)

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Early administration of tolvaptan preserves renal function in elderly patients with acute decompensated heart failure

Cited by 62 publications

References 31 publications

Effects of Additive Tolvaptan vs. Increased Furosemide on Heart Failure With Diuretic Resistance and Renal Impairment　― Results From the K-STAR Study ―

Effects of Additive Tolvaptan vs. Increased Furosemide on Heart Failure With Diuretic Resistance and Renal Impairment　― Results From the K-STAR Study ―

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

Successful Treatment of Congestive Heart Failure Due to Severe Aortic Valve Stenosis With Low Dose Tolvaptan in Elderly Patients

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Early administration of tolvaptan preserves renal function in elderly patients with acute decompensated heart failure

Cited by 62 publications

References 31 publications

Effects of Additive Tolvaptan vs. Increased Furosemide on Heart Failure With Diuretic Resistance and Renal Impairment ― Results From the K-STAR Study ―

Effects of Additive Tolvaptan vs. Increased Furosemide on Heart Failure With Diuretic Resistance and Renal Impairment ― Results From the K-STAR Study ―

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

Successful Treatment of Congestive Heart Failure Due to Severe Aortic Valve Stenosis With Low Dose Tolvaptan in Elderly Patients

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Effects of Additive Tolvaptan vs. Increased Furosemide on Heart Failure With Diuretic Resistance and Renal Impairment　― Results From the K-STAR Study ―

Effects of Additive Tolvaptan vs. Increased Furosemide on Heart Failure With Diuretic Resistance and Renal Impairment　― Results From the K-STAR Study ―