Tolvaptan for Volume Management in Heart Failure

Gunderson, Erik G.; Lillyblad, Matthew P.; Fine, Michelle; Vardeny, Orly; Berei, Theodore J.

doi:10.1002/phar.2239

Cited by 14 publications

(10 citation statements)

References 45 publications

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“…7 Although the main indication of tolvaptan is the management of euvolemic and hypervolemic hyponatremia, 8 growing evidence supports its efficacy in alleviating congestive symptoms in patients with acute heart failure 9 and managing fluid retention in the setting of cardiac surgery. 11 On the other hand, treatment with tolvaptan has been associated with increased liver toxicity, 12 which may be caused by direct DNA damage and by delayed progression of the cell cycle and induction of apoptosis in hepatocytes. 11 On the other hand, treatment with tolvaptan has been associated with increased liver toxicity, 12 which may be caused by direct DNA damage and by delayed progression of the cell cycle and induction of apoptosis in hepatocytes.…”

Section: Introductionmentioning

confidence: 99%

“…10 More specifically, tolvaptan has been suggested to improve prognosis of patients with congestive heart failure by effectively decreasing bodyweight and restoring sodium levels, without jeopardizing renal function. 11 On the other hand, treatment with tolvaptan has been associated with increased liver toxicity, 12 which may be caused by direct DNA damage and by delayed progression of the cell cycle and induction of apoptosis in hepatocytes. 13 It has been recently proposed that tolvaptan represents a promising add-on treatment in patients with refractory ascites due to liver cirrhosis, as it has been shown not only to correct hyponatremia but also to improve long-term prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of tolvaptan short‐term response in patients with refractory ascites: A meta‐analysis

Bellos

Kontzoglou

Perrea

2019

J of Gastro and Hepatol

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Background and Aim Tolvaptan represents an oral V2‐receptor antagonist, which has been suggested as a promising add‐on diuretic treatment for refractory ascites. The present meta‐analysis aims to accumulate current evidence and identify which clinical and laboratory factors are linked to short‐term response to tolvaptan therapy. Methods Medline, Scopus, Cochrane Central Register of Controlled Trials, http://Clinicaltrials.gov, and Google Scholar databases were searched from inception. All observational studies reporting the correlation of patients' characteristics with tolvaptan response were selected. Results Tolvaptan response was associated with significantly higher baseline body weight (mean difference: 4.59 kg, 95% confidence interval [CI]: [3.58, 5.61]), presence of hepatitis C (odds ratio: 1.59 95% CI: [1.18, 2.14]), lower blood urea nitrogen (BUN) (mean difference: −6.88 mg/dL, 95% CI: [−8.13, −5.63]), lower serum creatinine (mean difference: −0.17 mg/dL, 95% CI: [−0.30, −0.05]), lower C‐reactive protein (mean difference: −1.43 mg/dL, 95% CI: [−2.52, −0.35]), and higher sodium levels (mean difference: 1.00 mEq/L, 95% CI: [0.45, 1.55]). The outcomes of bodyweight, hepatitis C, BUN, and C‐reactive protein remain significant independently of response definition and risk of bias. Conclusions The present findings suggest bodyweight, BUN, C‐reactive protein, and hepatitis C as potential predictive factors of tolvaptan short‐term response in patients with refractory ascites. Future studies are needed to introduce cut‐off values and construct an optimal combined screening model.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictors of tolvaptan short‐term response in patients with refractory ascites: A meta‐analysis

Bellos

Kontzoglou

Perrea

2019

J of Gastro and Hepatol

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“…При выраженной гиперволемической гипонатриемии (концентрация Na + в плазме крови ниже 125 ммоль/л) может потребоваться более жесткое ограничение (до 800-1 000 мл/сут) потребления жидкости [51]. При гипонатриемии разведения показано применение селективного, конкурентного антагони-ста V2-рецептора вазопрессина толваптана (в настоящее время изучается эффективность и безопасность других ваптанов, в частности неселективного антагониста V1a/V2-рецепторов вазопрессина пекаваптана [61]), без которого в такой ситуации эффективное и быстрое преодоление РД практически невозможно [62,63].…”

Section: профилактика и преодоление резистентности к диуретикамunclassified

Diuretic resistance in patients with chronic heart failure: mechanisms, prevention, and treatment

et al. 2022

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The authors analyzed the problem of diuretic resistance (DR) in patients with chronic heart failure (CHF). Most of the symptoms and signs of CHF are associated with hypervolemia and vascular congestion in the systemic and pulmonary circulation. The severity of the latter is the main factor which negatively affects the overall assessment of life satisfaction in patients with CHF. Since the patient, even at the incurable stage of CHF, primarily expects a rapid decrease in the severity of manifestations of decompensation from the prescribed therapy, achieving euvolemia is the essence of its short-term objective. Without diuretics, these immediate effects, according to which most CHF patients judge the qualifications of the doctor, are almost impossible to achieve. Unfortunately, apparently, not a single clinician was able to avoid disappointment in the effectiveness of CHF therapy associated with DR in their practice. As a rule, DR reflects the progressive course of CHF and is often associated with a poor prognosis. The review consistently covers the issues of terminology, diagnosis, pathogenesis, and prevention of DR, which aggravates CHF, and discusses measures aimed at restoring sensitivity to diuretics.

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“…Tolvaptan can decrease body weight, increase serum sodium level, and ameliorate some congestion symptoms in patients with ADHF, which may help prevent overdose of loop diuretics, especially in patients with renal dysfunction [ 4 ]. A meta-analysis of the published literature suggests short-term benefits of tolvaptan, but the impact on mortality is inconclusive [ 4 – 7 ]. The serum sodium level increases as a result of aquaresis in almost all cases, and hypernatremia can be lethal in some patients [ 8 , 9 ] and was identified as a significant adverse event to be prevented [ 10 ].…”

Section: Backgroundsmentioning

confidence: 99%

Tolvaptan-induced hypernatremia related to low serum potassium level accompanying high blood pressure in patients with acute decompensated heart failure

Fukuoka¹,

Tachibana²,

Shinoda³

et al. 2020

BMC Cardiovasc Disord

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Backgrounds Tolvaptan significantly increases urine volume in acute decompensated heart failure (ADHF); serum sodium level increases due to aquaresis in almost all cases. We aimed to elucidate clinical factors associated with hypernatremia in ADHF patients treated with tolvaptan. Methods We enrolled 117 ADHF patients treated with tolvaptan in addition to standard therapy. We examined differences in clinical factors at baseline between patients with and without hypernatremia in the initial three days of hospitalization. Results Systolic (p = 0.045) and diastolic (p = 0.004) blood pressure, serum sodium level (p = 0.002), and negative water balance (p = 0.036) were significantly higher and serum potassium level (p = 0.026) was significantly lower on admission day in patients with hypernatremia (n = 22). In multivariate regression analysis, hypernatremia was associated with low serum potassium level (p = 0.034). Among patients with serum potassium level ≤ 3.8 mEq/L, the cutoff value obtained using receiver operating characteristic curve analysis, those with hypernatremia related to tolvaptan treatment showed significantly higher diastolic blood pressure on admission day (p = 0.004). Conclusion In tolvaptan treatment combined with standard therapy in ADHF patients, serum potassium level ≤ 3.8 mEq/L may be a determinant factor for hypernatremia development. Among hypokalemic patients, those with higher diastolic blood pressure on admission may be carefully managed to prevent hypernatremia.

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Tolvaptan for Volume Management in Heart Failure

Cited by 14 publications

References 45 publications

Predictors of tolvaptan short‐term response in patients with refractory ascites: A meta‐analysis

Predictors of tolvaptan short‐term response in patients with refractory ascites: A meta‐analysis

Diuretic resistance in patients with chronic heart failure: mechanisms, prevention, and treatment

Tolvaptan-induced hypernatremia related to low serum potassium level accompanying high blood pressure in patients with acute decompensated heart failure

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