Safety and Efficacy of Long-Term Use of Tolvaptan in Patients With Heart Failure and Chronic Kidney Disease

Uemura, Yoshiko; Shibata, Rei; Takemoto, Kenji; Uchikawa, Tomohiro; Koyasu, Masayoshi; Ishikawa, Shinya; Imai, Ryo; Ozaki, Yuta; Watanabe, Takashi; Teraoka, Tsubasa; Watarai, Masato; Murohara, Toyoaki

doi:10.1253/circj.cj-17-0554

Cited by 18 publications

(18 citation statements)

References 7 publications

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“…The primary endpoint of this study was rehospitalization due to worsening HF, and the secondary endpoints Kaplan-Meier analysis revealed that the incidence of rehospitalization was significantly lower in the TLV (+) group than in the TLV (−) group (log-rank test; p = 0.018) ( Figure 2). As shown in 18,19 In our study, 82.8% of the patients started TLV therapy from the first day of hospitalization, and TLV therapy reduced loop diuretics doses both at discharge and after 6 months, and it also prevented WRF development until 6 months…”

Section: Echocardiographysupporting

confidence: 68%

Efficacy of Tolvaptan in Elderly Patients with Heart Failure and Preserved Ejection Fraction

Suzuki

Murata

Tsujimoto

et al. 2019

Journal of Cardiovascular Emergencies

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Background: There is no known therapy with proven efficacy for improving clinical outcomes in elderly patients with heart failure (HF) and preserved ejection fraction (HFpEF). In this study, we aimed to evaluate the efficacy of tolvaptan (TLV) in elderly HFpEF patients. Methods: This retrospective observational study involved 100 consecutive elderly HFpEF patients hospitalized at the Nagoya Heart Center, Japan. Inclusion criteria were: (1) patients aged ≥75 years; (2) first hospitalization secondary to HF; (3) received medical therapy for HF, without invasive treatment; and (4) clinical follow-up for >6 months after discharge. The primary endpoint was rehospitalization due to worsening HF, and the secondary endpoint was worsening renal function (WRF) during hospitalization and at 6 months after discharge. Sixty background-matched HFpEF patients were divided into 2 groups: with TLV therapy (TLV (+), n = 29) and without TLV therapy (TLV (–), n = 31). In the TLV (+) group, TLV therapy was continued after discharge. Clinical outcomes of these patients were evaluated. Results: Bed rest period and length of hospital stay were significantly shorter in the TLV (+) group than in the TLV (−) group. The dose of loop diuretics, mean serum creatinine levels, and incidence of WRF development were significantly lower in the TLV (+) group. Incidence of rehospitalization was also significantly lower in the TLV (+) group (log-rank test; p = 0.018). The multivariate logistic regression analysis demonstrated that TLV therapy reduces the incidence of rehospitalization in elderly patients with HFpEF. Conclusions: TLV therapy reduced the bed rest period, length of hospital stay, and rate of rehospitalization without WRF in elderly HFpEF patients, suggesting that TLV could represent an effective therapy for this group of patients.

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Section: Echocardiographysupporting

confidence: 68%

Efficacy of Tolvaptan in Elderly Patients with Heart Failure and Preserved Ejection Fraction

Suzuki

Murata

Tsujimoto

et al. 2019

Journal of Cardiovascular Emergencies

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“…_ 1 ) T D $ F I G ] renal function is a key to better prognosis in HF patients. Table 2 summarizes the results of six long-term tolvaptan therapy studies, including four Japanese ones [27,[31][32][33][34]. Tolvaptan dose ranges were 4.9-9.8 mg/day in four Japanese studies, whereas two studies in other countries were performed at 30 mg/day [20,35].…”

Section: Renal Functionmentioning

confidence: 99%

Update of acute and long-term tolvaptan therapy

Imamura

Kinugawa

2019

Journal of Cardiology

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“…However, those were reports on the short‐term use of TLV. Studies on the long‐term use of TLV reported a decrease in the rate of re‐hospitalization due to cardiac failure and fewer instances of renal function worsening . TLV therapy was also reported to be more effective in maintaining renal function than increasing the dose of loop diuretics .…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have also reported on the efficacy of TLV in patients with CKD and heart failure . Furthermore, in recent years, it has been reported that long‐term administration of TLV in the management of heart failure suppressed re‐hospitalization rates and also decreased the worsening of renal function . In heart failure complicated with advanced CKD, repeated hospitalization for heart failure is one of the main reasons for initiating dialysis.…”

mentioning

confidence: 99%

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

et al. 2019

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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.

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Safety and Efficacy of Long-Term Use of Tolvaptan in Patients With Heart Failure and Chronic Kidney Disease

Cited by 18 publications

References 7 publications

Efficacy of Tolvaptan in Elderly Patients with Heart Failure and Preserved Ejection Fraction

Efficacy of Tolvaptan in Elderly Patients with Heart Failure and Preserved Ejection Fraction

Update of acute and long-term tolvaptan therapy

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

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