Effects of short-term administration of tolvaptan after open heart surgery

Matsuyama, Katsuhiko; Koizumi, Noriko; Nishibe, Toshiya; Iwasaki, Tomoaki; Iwahasi, Toru; Toguchi, Kayo; Takahashi, Satoshi; Iwahori, Akinari; Maruno, Keita; Ogino, Hitoshi

doi:10.1016/j.ijcard.2016.06.156

Cited by 19 publications

(35 citation statements)

References 10 publications

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“…Several studies have assessed the efficacy of tolvaptan after cardiac surgery. 14,17- 19 Nishi et al reported that tolvaptan was effective in treating fluid retention, without inducing renal failure or abnormal electrolyte levels, during the postoperative stage following cardiac surgery. 17 Furthermore, Kato et al reported that tolvaptan administration in patients undergoing cardiac surgery improves renal perfusion.…”

Section: Discussionmentioning

confidence: 99%

“…However, few studies have clarified the efficacy of tolvaptan in patients who have undergone open heart surgery using a prospective randomized design. 19 To the best of our knowledge, the present prospective randomized study on the efficacy of tolvaptan in patients undergoing cardiac surgery uses the largest patient population to date. Thus, we believe that the present study provides important evidence, further clarifying the efficacy of tolvaptan with regard to its effectiveness and safety for the management of body fluid levels in patients during the early postoperative period of cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

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Can Tolvaptan Protect Renal Function in the Early Postoperative Period of Cardiac Surgery?　― Results of a Single-Center Randomized Controlled Study ―

Kishimoto

Nakamura

Harada

et al. 2018

Circ J

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Background: Oral administration of tolvaptan, a vasopressin V2 receptor antagonist, significantly reduces deterioration of renal function, which has recently been highlighted as an exacerbating factor for adverse events in patients with acute heart failure. In the present study we tested the hypothesis that concomitant administration of tolvaptan with a conventional diuretic is beneficial for perioperative body fluid management in patients who have undergone cardiac surgery. Methods and Results:In all, 280 patients who underwent cardiac surgery were prospectively randomized to concomitant treatment with tolvaptan and a conventional diuretic (tolvaptan group; 147 patients) or treatment with a conventional diuretic alone (control group; 133 patients). Groups were compared in terms of the time required to restore preoperative body weight and the incidence of worsening renal function (WRF), defined as an increase in the serum creatinine level ≥0.3 mg/dL. The time required to restore preoperative body weight was significantly shorter in the tolvaptan than control group (mean [±SD] 3.97±1.95 vs. 5.02±2.83 days, respectively; P<0.001). The incidence of WRF was significantly lower in the tolvaptan than control group (n=11 [7.5%] vs. n=25 [18.8%], respectively; P=0.011). Conclusions:Administration of tolvaptan with conventional diuretics in the early postoperative period after cardiac surgery could be beneficial in maintaining urine output without affecting renal function and may thus help avoid WRF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Can Tolvaptan Protect Renal Function in the Early Postoperative Period of Cardiac Surgery?　― Results of a Single-Center Randomized Controlled Study ―

Kishimoto

Nakamura

Harada

et al. 2018

Circ J

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“…There was no statistical significant difference in BUN between the two groups; however, FEUN was significantly higher on postoperative day 2 and 5 in the tolvaptan group. In the study of Matsuyama et al (16), no significant difference was evident in serum creatinine and BUN levels between the two groups except on postoperative day 3 when the levels were significantly lower in the tolvaptan group. Suehiro et al (18) found no significant difference in the highest serum creatinine levels between the two study groups.…”

Section: Resultsmentioning

confidence: 81%

“…5). Descriptive analysis of results from three studies indicated no significant difference in mean serum potassium levels between the two study groups (2,16,17).…”

Section: Resultsmentioning

confidence: 91%

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Efficacy of tolvaptan for fluid management after cardiovascular surgery: A systematic review and meta‑analysis of randomized control trials

Chen

Jiang

et al. 2020

Exp Ther Med

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The purpose of this study was to systematically search the literature and analyze evidence from randomized controlled trials (RCTs) comparing tolvaptan with conventional diuretics for postoperative fluid management in cardiac surgery patients. An electronic search of PubMed, Scopus, BioMed Central, CENTRAL (Cochrane Central Register of Controlled Trials) and Google scholar databases was carried out up to 1st December 2019. Four RCTs were included. Tolvaptan was co-administered with conventional diuretics in all the studies. The mean postoperative urine output was significantly greater in patients receiving tolvaptan as compared to controls (MD=0.39; 95% CI: 0.17 to 0.61; P=0.006, I 2 =48%). Body weight of patients on tolvaptan returned to pre-operative levels significantly earlier (MD=-1.57; 95% CI:-2.48 to-0.66; P=0.007, I 2 =50%). There was statistical significant difference in the highest postoperative serum sodium levels (MD=2.34; 95% CI:-1.65 to 3.03; p<0.00001, I 2 =0%), lowest serum sodium levels (MD=2.05; 95% CI: 1.41 to 2.68; p<0.00001, I 2 =0%) and mean serum sodium levels (MD=1.69; 95% CI: 0.98 to 2.40; p<0.00001, I 2 =0%) between the tolvaptan and control groups. Lowest serum potassium was significantly higher with tolvaptan as compared to the control group (MD=0.10; 95% CI: 0.01 to 0.18; P=0.03, I 2 =19%). There was no significant difference in the length of ICU stay or incidence of arrhythmias between the two groups. The quality of the included studies was not high. Within the limitations of our study, our results indicate that co-administration of tolvaptan with low dose of conventional diuretics significantly increases urine output while maintaining electrolyte balance in postoperative cardiac surgery patients. Faster return of body weight to pre-operative levels is evident with tolvaptan. Further high-quality RCTs are required to confirm this evidence.

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Perioperative urinary excretion of aquaporin-2 dependent upon vasopressin in cardiac surgery

2019

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Effects of short-term administration of tolvaptan after open heart surgery

Cited by 19 publications

References 10 publications

Can Tolvaptan Protect Renal Function in the Early Postoperative Period of Cardiac Surgery?　― Results of a Single-Center Randomized Controlled Study ―

Can Tolvaptan Protect Renal Function in the Early Postoperative Period of Cardiac Surgery?　― Results of a Single-Center Randomized Controlled Study ―

Efficacy of tolvaptan for fluid management after cardiovascular surgery: A systematic review and meta‑analysis of randomized control trials

Perioperative urinary excretion of aquaporin-2 dependent upon vasopressin in cardiac surgery

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Effects of short-term administration of tolvaptan after open heart surgery

Cited by 19 publications

References 10 publications

Can Tolvaptan Protect Renal Function in the Early Postoperative Period of Cardiac Surgery? ― Results of a Single-Center Randomized Controlled Study ―

Can Tolvaptan Protect Renal Function in the Early Postoperative Period of Cardiac Surgery? ― Results of a Single-Center Randomized Controlled Study ―

Efficacy of tolvaptan for fluid management after cardiovascular surgery: A systematic review and meta‑analysis of randomized control trials

Perioperative urinary excretion of aquaporin-2 dependent upon vasopressin in cardiac surgery

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Can Tolvaptan Protect Renal Function in the Early Postoperative Period of Cardiac Surgery?　― Results of a Single-Center Randomized Controlled Study ―

Can Tolvaptan Protect Renal Function in the Early Postoperative Period of Cardiac Surgery?　― Results of a Single-Center Randomized Controlled Study ―