Background: Given that residual congestion is a predictor of poor outcome in patients with
heart failure (HF), a therapeutic strategy for decongestion is required. Methods and Results: Eighteen HF patients with fluid retention despite oral
furosemide >20 mg/day, with
chronic kidney disease (CKD; estimated glomerular filtration rate [eGFR], <59 mL/min/1.73 m2) were enrolled. Patients were randomized into 2 groups: a
tolvaptan group (
tolvaptan, 7.5 mg/day, n=10) and a
furosemide group (additional
furosemide 20 mg/day, n=8), and followed up for 7 days. The urine volume significantly increased on day 3 in the
tolvaptan group but not in the
furosemide group. The
body weight significantly decreased in the
tolvaptan compared with the
furosemide group on days 3 and 5. Although there was no difference in serum
creatinine or eGFR in the 7 days between the 2 groups, serum
cystatin C significantly decreased on day 7 in the
tolvaptan group compared with the
furosemide group. The residual congestion was more improved in the
tolvaptan group than in the
furosemide group. Conclusions: Adding
tolvaptan but not
furosemide significantly increased urine volume, decreased
body weight and improved residual congestion without affecting the renal function or
electrolytes in patients with HF with CKD under
furosemide treatment.