Abstract 10772: Could Tolvaptan Protect Renal Function in the Early Postoperative Period After Cardiac Surgery?

Abstract

Introduction: Tolvaptan (TV), a vasopressin V2 inhibitor, has a strong diuretic effect, which is beneficial for body fluid management in patients with acute heart failure (AHF). Several studies have reported that TV significantly reduces worsening renal function (WRF), which has recently been highlighted as an exacerbation factor in the treatment of AHF. We hypothesized that concomitant administration of TV with conventional diuretic treatment is beneficial for perioperative body fluid management in patients who have undergone cardiac surgery. In this study, we prospectively randomized the patients into the TV group, in which TV was administered in addition to conventional diuretics, and the control group, in which the patients received conventional diuretics only. Methods: A total of 176 patients who underwent cardiac surgery were divided into 2 groups, which were the TV group (TV + furosemide, 90 patients) and conventional diuretic treatment group (Control [C], furosemide with or without spironolactone, 86 patients). We compared urine output for 3 days after surgery, the time required to restore the preoperative body weight, and the incidence of WRF between the 2 groups. In the TV group, patients received TV 7.5mg/day orally starting on POD1 and continued to take TV up to POD 5. WRF was defined as a rise in the serum creatinine level (Cr) of ≥0.3 mg/dL. Results: The mean daily urine output from POD1 to POD 3 of the TV group (2672 ± 769 mL/day) was higher than that of the C group (2240 ± 529 mL/day) (p = 0.001). The time required to restore preoperative body weight was shorter in the TV group (3.8 ± 1.4 days) than in the C group (4.8 ± 2.0 days) (p=0.003). While the highest postoperative Cr of the TV group (1.01 ± 0.50 mg/dL) was the same as that of the C group (1.16 ± 0.91 mg/dL) (p=0.25), the incidence of WRF in the TV group (9 patients, 10%) was significantly lower than in the C group (24 patients, 28%) (p=0.007), which might indicate the protective effect of TV against WRF in the patients undergoing cardiac surgery. Conclusions: Administration of TV with conventional diuretics in the early postoperative period after cardiac surgery could be beneficial in maintaining urine output without affecting renal function, which may help to avoid WRF after cardiac surgery.