Hemodynamic and Hormonal Effects of Tolvaptan for Heart Failure

Abstract

Tolvaptan (TLV) is a diuretic agent administrated for heart failure (HF) only in Japan. Many clinical findings have been obtained from the accumulation of clinical experience, and the administration of TLV reportedly avoids causing a reduction in the renal function. In addition, TLV has been reported to exert effects other than diuresis. The early start of TLV after hospitalization shortens the length of the hospital stay, and continuous TLV after discharge extends the period until re-hospitalization of HF patients. TLV is thought to function via vasopressin V2 receptor antagonism. However, no significant differences in the long-term prognosis were noted between the group using TLV and not using TLV in the EVEREST trial, and effects other than diuresis are not useful for all HF patients. Therefore, it is necessary to identify patients who may experience effects other than diuresis with TLV administration. The accumulation of more patients and findings from further large-scale clinical trials will be necessary in order to clarify these points.

Impact of Tolvaptan Combined with Low-Dose Dopamine in Heart Failure Patients with Acute Kidney Injury

“…Clinical practices have shown that tolvaptan can effectively improve the symptoms of HF patients compared with traditional loop diuretic therapy. [14][15][16] In addition to improving cardiac performance, tolvaptan was thought to enhance renal function by encouraging water excretion with electrolyte-free. 17) In- travascular volume depends on serum osmotic pressure and colloid osmotic pressure.…”