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International Urology and Nephrology
Published in: International Urology and Nephrology 9/2019

01-09-2019 | Chronic Kidney Disease | Nephrology - Original Paper

Impact of serum albumin levels on the body fluid response to tolvaptan in chronic kidney disease patients

Authors: Takahiro Masuda, Ken Ohara, Izumi Nagayama, Ryo Matsuoka, Takuya Murakami, Saki Nakagawa, Kentanro Oka, Maki Asakura, Yusuke Igarashi, Yukimura Fukaya, Yasuharu Miyazawa, Akito Maeshima, Tetsu Akimoto, Osamu Saito, Daisuke Nagata

Published in: International Urology and Nephrology | Issue 9/2019

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Abstract

Purpose

Tolvaptan exerts an aquaretic effect by blocking vasopressin V2 receptor. Although tolvaptan ameliorates body fluid retention even in patients with chronic kidney disease (CKD), predictors of body fluid reduction induced by tolvaptan remain unclear. We, therefore, examined the clinical parameters associated with the effect of tolvaptan on fluid volume in CKD patients.

Methods

Twelve CKD patients (stage 3–5) with fluid retention were treated with tolvaptan in addition to conventional diuretic treatment. Patients were divided into low and high responders by the median change in total body water (TBW) for 1 week measured by a bioimpedance analysis (BIA) device, and clinical parameters were compared between the groups.

Results

The body weight significantly decreased by 2.0 ± 2.3 kg (p = 0.005), but the estimated glomerular filtration rate (eGFR) was not significantly changed (16.9 ± 11.9 vs. 17.4 ± 12.4 mL/min/1.73 m2, p = 0.139) after 1 week. The BIA showed that the intracellular water (ICW) decreased by 6.0% ± 4.7% (p < 0.001), the extracellular water (ECW) decreased by 6.7% ± 5.4% (p = 0.001), and the TBW decreased by 6.3% ± 4.9% (median value − 6.02%, p < 0.001). The serum albumin level in the high responders was significantly lower than in the low responders (2.3 ± 0.5 vs. 3.3 ± 0.8 g/dL, p = 0.013). Significant partial correlations adjusted for the eGFR were observed between the baseline serum albumin level and changes in the ICW (r = 0.440, p = 0.048), ECW (r = 0.593, p = 0.009) and TBW (r = 0.520, p = 0.020).

Conclusions

Serum albumin levels predict the body fluid response to tolvaptan in CKD patients. Tolvaptan may be a promising therapeutic option for ameliorating body fluid retention, especially in patients with hypoalbuminemia.
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Metadata
Title
Impact of serum albumin levels on the body fluid response to tolvaptan in chronic kidney disease patients
Authors
Takahiro Masuda
Ken Ohara
Izumi Nagayama
Ryo Matsuoka
Takuya Murakami
Saki Nakagawa
Kentanro Oka
Maki Asakura
Yusuke Igarashi
Yukimura Fukaya
Yasuharu Miyazawa
Akito Maeshima
Tetsu Akimoto
Osamu Saito
Daisuke Nagata
Publication date
01-09-2019
Publisher
Springer Netherlands
Published in
International Urology and Nephrology / Issue 9/2019
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI
https://doi.org/10.1007/s11255-019-02180-8

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