Effects of Tolvaptan on Volume Overload in Patients with Heart Failure

Abstract

The present meta-analysis aimed to evaluate effects of tolvaptan on fluid retention in patients with heart failure who were non-responsive to conventional treatment and to assess differences between effects of low (! 15 mg/day) and high (> 15 mg/day) tolvaptan doses. Randomized controlled trials comparing add-on tolvaptan therapy and placebo or therapy with other diuretics in patients with heart failure were identified through a database search. The primary outcomes were changes in body weight and urine volume, and the secondary outcomes were changes in serum sodium and creatinine levels. In total, 14 reports were analyzed using a random effects model. Add-on tolvaptan was associated with increased urine volume [mean difference (MD), 1.44 L; 95% confidence interval (CI), 0.96 to 1.92], decreased body weight (MD, −0.99 kg; 95% CI, −1.24 to −0.74), and increased serum sodium levels (MD, 3.66 mEq/L; 95% CI, 3.43 to 3.88) within 2 days. Serum creatinine levels on day 7 were not different between the groups (MD, −0.03 mg/dL; 95% CI, −0.09 to 0.03). The high-dose group showed greater changes in urine volume, body weight, and serum sodium levels than the low-dose group. Serum creatinine levels slightly increased in the high-dose group (MD, 0.06; 95% CI, 0.04 to 0.08) and slightly decreased in the low-dose group (MD, −0.10; 95% CI, −0.19 to −0.01). Our findings suggest that add-on tolvaptan therapy for heart failure improves fluid retention in the early therapy phase. However, this drug should be properly used to avoid the worsening of renal function, which may occur at high doses.

Clinical Characteristics and Long-Term Outcomes of Patients with Acute Decompensated Heart Failure with Mid-Range Ejection Fraction

“…In patients with HFpEF, the use of diuretics and the treatment of comorbidities are recommended in order to alleviate the symptoms and signs of HF. 14,30,31) In patients with HFmrEF, prognostic and therapeutic evidence is still limited.…”

Integration of a palliative approach into heart failure care: a European Society of Cardiology Heart Failure Association position paper

“…Many of these patients have interlinking comorbidities, therefore their final few months of life may be characterized by distressing, debilitating and refractory symptoms, arising from both cardiac and non‐cardiac conditions, including cancer ( Table 1 ). 24,66–92 Patients are also subject to the practical, psychological and social consequences of living with a chronic progressive disease, or the side effects of medications 63,85,93 . Symptoms can cluster, and whilst they can be mitigated to some extent, toward the end of life, they can seem overwhelming.…”

Short-Term Efficacy and Safety of Tolvaptan in Patients with Left Ventricular Assist Devices

“…Owing to its unique aquaretic effect, evidence for the efficacy of tolvaptan therapy for hospitalized HF patients has been accumulating as it leads to improvement in congestive symptoms and ameliorates hyponatremia. [15][16][17] Despite this, in the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan trial, tolvaptan therapy increased weight loss during hospitalization, but had no effect on long-term mortality or HF hospitalizations. 16,28 Adding tolvaptan to conventional diuretic therapy may decrease the dose of loop diuretics and prevent worsening renal function during decongestion.…”

“…15 Reports have demonstrated efficacy of short-term use of tolvaptan for acute HF patients with symptomatic congestion and hyponatremia. 16,17 However, the use of tolvaptan in LVAD patients has only been described in case reports. 18 The aim of this study is to investigate the clinical efficacy and safety of tolvaptan in LVAD patients.…”