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28.11.2015 | Original Article | Ausgabe 10/2016

Heart and Vessels 10/2016

Clinical benefit of tolvaptan in patients with acute decompensated heart failure and chronic kidney disease

Zeitschrift:
Heart and Vessels > Ausgabe 10/2016
Autoren:
Yusuke Uemura, Rei Shibata, Kenji Takemoto, Tomohiro Uchikawa, Masayoshi Koyasu, Shinji Ishikawa, Takayuki Mitsuda, Ayako Miura, Ryo Imai, Satoshi Iwamiya, Yuta Ozaki, Tomohiro Kato, Takanori Miura, Masato Watarai, Toyoaki Murohara

Abstract

Tolvaptan, a vasopressin type 2 receptor antagonist, has an aquaretic effect without affecting renal function. The effects of long-term tolvaptan administration in heart failure patients with renal dysfunction have not been clarified. Here, we assessed the clinical benefit of tolvaptan during a 6-month follow-up in acute decompensated heart failure (ADHF) patients with severe chronic kidney disease (CKD; estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2). We compared 33 patients with ADHF and severe CKD who were administered tolvaptan in addition to loop diuretics (TLV group), with 36 patients with ADHF and severe CKD who were administered high-dose loop diuretics (≥40 mg) alone (LD group). Alterations in serum creatinine and eGFR levels from the time of hospital discharge to 6-month follow-up were significantly different between the groups, with those in the TLV group being more favorable. Furthermore, Kaplan–Meier analysis revealed that rehospitalization for heart failure (HF) was significantly lower in the TLV group compared with the LD group. In ADHF patients with severe CKD, tolvaptan use for 6 months reduced worsening of renal function and rehospitalization rates for HF when compared with conventional diuretic therapy. In conclusion, tolvaptan could be a safe and effective agent for long-term management of HF and CKD.

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