Successful treatment with tolvaptan to control blood volume and hyponatremia in a chronic kidney disease patient

Abstract

We report a case of successful treatment with tolvaptan (15 mg/day) in a 73-year-old female patient with chronic kidney disease (CKD) stage 5 due to diabetic nephropathy and renal sclerosis for volume control and loop diuretic-induced hyponatremia. Her creatinine clearance has remained at 7-10 ml/min for the last 6 months. She was treated by dietary and drug therapy, namely, antihypertensives (nifedipine: 40 mg/day, olmesartan: 20 mg/ day) and loop diuretics (azosemide: 40-120 mg/day), for CKD and concomitant diseases of hypertension and diabetic mellitus. She developed loop diuretic-induced hyponatremia (120 mmol/l) by increased sodium excretion, but the diuretic was required for the control of volume overload. Hence, azosemide was suspended and tolvaptan (15 mg/day) was administered. After tolvaptan treatment, the plasma sodium level gradually increased to a normal level (135-140 mmol/l) and volume overload was improved. Urine volume was maintained at about 1000 ml/ day with low sodium excretion (\40 mmol/day) and increased free water clearance. These results suggest that tolvaptan may be effective for volume control and diureticinduced hyponatremia in CKD patients.

Dual Impact of Tolvaptan on Intracellular and Extracellular Water in Chronic Kidney Disease Patients with Fluid Retention

“…The equivalent efficacy of tolvaptan on ICW and ECW may contribute to preserve the renal function. Although loop diuretics have been associated with adverse effects, particularly a worsening renal function ( 3 , 4 ), tolvaptan is an effective water diuretic with no apparent adverse effects on the renal function ( 13 , 15 , 17 ). In this study, tolvaptan administration for advanced CKD patients was also effective for volume control without a worsening renal function.…”