Efficacy of Long‐Term Treatment With Tolvaptan to Prolong the Time Until Dialysis Initiation in Patients With Chronic Kidney Disease and Heart Failure

Abstract

The short‐term effectiveness of tolvaptan (TLV) against heart failure has been established. TLV is known to decrease the worsening of renal function more than loop diuretics. Long‐term TLV administration decreases the rate of re‐hospitalization in heart failure and prevents deterioration of kidney function. If repeated hospitalization for heart failure can be prevented in patients having concurrent chronic kidney disease (CKD), the period until dialysis initiation may be prolonged. We investigated whether long‐term TLV management can extend the period until dialysis initiation in patients with CKD and heart failure. A retrospective, observational study was conducted among patients with CKD stage G4 and G5 admitted because of heart failure between April 2013 and July 2018. They were divided into those with TLV and those without TLV. They were followed up until August 2018 and relevant data was collected. Data from 115 patients (68 men and 47 women), with a mean age of 73.4 ± 11.9 (median 76.0 and IQR 66.5–82.0) years and a mean eGFR of 11.8 ± 5.7 (median 9.9 and IQR 7.5–14.8) mL/min/1.73m2 were included in the analysis. Twenty‐five patients had received long‐term TLV treatment, and 90 had not. Multivariate analysis after adjustment showed that long‐term use of TLV significantly lowered the hazard ratio (HR) for time taken to reach dialysis initiation (HR: 0.3286, 95%CI: 0.1282–0.8423, P = 0.0205). Propensity score‐matched analysis showed similar results (HR: 0.3220, 95%CI: 0.1107–0.9369, P = 0.0376). In patients with CKD G4 and G5 and heart failure, long‐term treatment with TLV can prolong the time until dialysis initiation.

Cost-Effectiveness of long-term tolvaptan administration for chronic heart failure treatment in Japan

“…The details and results of the systematic review and meta-analysis are summarized in the Online materials. After the systematic review, we used nine studies as references in the cost-effectiveness analysis [23][24][25][26][27][28][29][30][31] . The characteristics of the studies are presented in Table 1 .…”

“…Nonetheless, in the EVEREST study, patients with severe renal dysfunction were excluded. Recently, several studies from Japan demonstrated that long-term TLV administration may be useful for the treatment of patients with CHF, especially in patients with high-dose loop diuretics and/or CKD [23][24][25][26][27][28][29][30][31] . Thus, we conducted this study to evaluate the efficacy and cost-effectiveness of long-term TLV administration in Japanese patients with CHF using a systematic review and meta-analysis and a simulation decision model.…”

“…While the effectiveness of TLV for ADHF treatment has been well established, long-term TLV administration for CHF treatment remains controversial. Although several recent studies have demonstrated the usefulness of TLV in patients with CHF, most of them had a small sample size and were observational studies [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] . Furthermore, the cost of TLV is much higher than that of other conventional drugs for HF treatment; however, no study has investigated the cost-effectiveness of long-term TLV administration for CHF treatment in Japan.…”

Management of Chronic Heart Failure in Dialysis Patients: A Challenging but Rewarding Path

“…Tolvaptan, a diuretic that selectively antagonizes arginine pressing V2 receptors and increases free water excretion by inhibiting water reabsorption in the collecting ducts, effectively reduces intra- and extracellular fluids, with the significant advantage of being less likely to cause deterioration in renal function [ 171 ]. Several studies have shown that treatment with tolvaptan prolongs the time to initiation of dialysis in CKD stage 4–5 patients with comorbid HF [ 172 , 173 ]. The use of tolvaptan in dialysis patients with RRF has been found to increase urine output with a favorable safety profile [ 171 , 174 ].…”

Tolvaptan ameliorated kidney function for one elderly autosomal dominant polycystic kidney disease patient: A case report

“…The efficacy of TLV has been reported for patients with CKD in other studies[ 7 , 8 ]. Recently, the administration of TLV also demonstrated that it decreased the worsening of renal function[ 9 , 10 ]. Furthermore, TLV therapy was more effective in maintaining renal function than treatment with increasing doses of loop diuretics because TLV has a strong diuretic effect.…”