Effects of tolvaptan in patients with chronic kidney disease and chronic heart failure.

Abstract

BACKGROUND:

Tolvaptan, a vasopressin V2 receptor blocker, has a diuretic effect for patients with heart failure. However, there were a few data concerning the effects of tolvaptan in patients with chronic kidney disease (CKD).

METHODS:

We retrospectively analyzed 21 patients with chronic heart failure and CKD. Tolvaptan was co-administered with other diuretics in-use, every day. We compared clinical parameters before and after the treatments with tolvaptan. Furthermore, we examined the correlations between baseline data and the change of body weight.

RESULTS:

Tolvaptan decreased the body weight and increased the urine volume (p = 0.001). The urine osmolality significantly decreased throughout the study period. Urinary Na/Cr ratio and FENa changed significantly after 4 h, and more remarkable after 8 h (p = 0.003, both). Serum creatinine increased slightly after 1 week of treatment (p = 0.012). The alteration of body weight within the study period correlated negatively with the baseline urine osmolality (r = -0.479, p = 0.038), the baseline urine volume (r = -0.48, p = 0.028), and the baseline inferior vena cava diameter (IVCD) (r = -0.622, p = 0.017). Hyponatremia was improved to the normal value, and the augmentations of the sodium concentration were negatively associated with the basal sodium levels (p = 0.01, r = -0.546).

CONCLUSIONS:

Tolvaptan is effective in increasing diuresis and improved hyponatremia, even in patients with CKD. The baseline urine osmolality, urine volume, and IVCD may be useful predictors for diuretic effects of tolvaptan.

• Authors: Mari Katsumata, Nobuhito Hirawa, Koichiro Sumida, Minako Kagimoto, Yosuke Ehara, Yuki Okuyama, Megumi Fujita, Akira Fujiwara, Mayumi Kobayashi, Yusuke Kobayashi, Yuichiro Yamamoto, Sanae Saka, Keisuke Yatsu, Tetsuya Fujikawa, Yoshiyuki Toya, Gen Yasuda, Kouichi Tamura, Satoshi Umemura
• Journal: Clinical and experimental nephrology (Clin Exp Nephrol) Vol. 21 Issue 5 Pg. 858-865 (Oct 2017) ISSN: 1437-7799 [Electronic] Japan
• PMID: 28190113 (Publication Type: Journal Article, Observational Study)

Chemical References

• Antidiuretic Hormone Receptor Antagonists
• Benzazepines
• Diuretics
• Tolvaptan
• Sodium

Topics

• Aged
• Antidiuretic Hormone Receptor Antagonists (adverse effects, therapeutic use)
• Benzazepines (adverse effects, therapeutic use)
• Diuresis (drug effects)
• Diuretics (adverse effects, therapeutic use)
• Female
• Heart Failure (complications, diagnosis, drug therapy, physiopathology)
• Humans
• Kidney (drug effects, physiopathology)
• Male
• Middle Aged
• Osmolar Concentration
• Renal Elimination (drug effects)
• Renal Insufficiency, Chronic (complications, diagnosis, physiopathology)
• Retrospective Studies
• Sodium (blood, urine)
• Time Factors
• Tolvaptan
• Treatment Outcome
• Urine (chemistry)
• Urodynamics (drug effects)
• Weight Loss (drug effects)