Published in:
Open Access
01-10-2017 | Original article
Effects of tolvaptan in patients with chronic kidney disease and chronic heart failure
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
Published in:
Clinical and Experimental Nephrology
|
Issue 5/2017
Login to get access
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.