Abstract
BackgroundTolvaptan, 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).MethodsWe 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.ResultsTolvaptan 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).ConclusionsTolvaptan 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.
Highlights
Tolvaptan is an oral diuretic with a new mechanism which selectivity binds to the V2 receptor as an antagonist. V2 receptors are located in the renal collecting duct, where arginine vasopressin (AVP) binding to the V 2 receptor leads to a rise in intracellular cAMP
We demonstrated that tolvaptan produced significant diuretic effects and reduced body weight in chronic kidney disease (CKD) patients
The reduction of body weight after administration of tolvaptan was correlated with the baseline urine volume, urine osmolality, and the inferior vena cava diameter (IVCD), but not with renal function in the study subjects
Summary
Tolvaptan is an oral diuretic with a new mechanism which selectivity binds to the V2 receptor as an antagonist. V2 receptors are located in the renal collecting duct, where arginine vasopressin (AVP) binding to the V 2 receptor leads to a rise in intracellular cAMP. V2 receptors are located in the renal collecting duct, where arginine vasopressin (AVP) binding to the V 2 receptor leads to a rise in intracellular cAMP. This promotes renal water reabsorption via translocation of intracellular vesicles containing the water channel aquaporin-2 into the apical plasma membrane and increased transcription of aquaporin-2 [1]. There are several adverse effects with taking loop diuretics. One. Tolvaptan, a vasopressin V2 receptor blocker, has a diuretic effect for patients with heart failure. 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. We examined the correlations between baseline data and the change of body weight
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