Abstract
(1) Background: It has been reported that tolvaptan (TLV) has a renoprotective effect in acute decompensated heart failure (ADHF) patients, but whether this effect is continued for a long time is unclear. Thus, we evaluated the time course of the renoprotective effect of TLV, in addition to the prognosis, in ADHF patients. (2) Methods: We investigated 911 ADHF patients from the AURORA (Acute Heart Failure Registry in Osaka Rosai Hospital) registry. After propensity score matching, 58 patients who started to receive TLV at least two days after the hospitalization (TLV group) and 58 who did not (non-TLV group) were examined. We compared the changes in the creatinine (Cr) and estimated glomerular filtration rate (eGFR) between baseline and each time point (five days, discharge, and one year) as the index of the renoprotective effect, and rate of rehospitalizations and all-cause mortality for one year between the two groups. (3) Results: The change in Cr and eGFR levels was significantly higher in the TLV group than the non-TLV group five days after admission but the difference between the two groups gradually diminished. A Kaplan–Meier analysis showed that the survival and rehospitalization rates in the TLV and non-TLV groups were similar up to one year. (4) TLV revealed a temporal change in the renoprotective effect, which may be correlated with no long-term beneficial effect of TLV.
Highlights
Acute decompensated heart failure (ADHF) is one of the leading causes of hospital admissions, and the standard treatment is usually pharmacologic involving loop diuretics [1]
Loop diuretics may lead to a worsening renal function (WRF), which in turn can lead to increased morbidity and mortality [2]
There were 911 ADHF patients who were admitted to have their HF managed in our hospital from the AURORA registry
Summary
Acute decompensated heart failure (ADHF) is one of the leading causes of hospital admissions, and the standard treatment is usually pharmacologic involving loop diuretics [1]. There has been growing interest in alternative strategies to manage the volume overload in ADHF patients. Tolvaptan (TLV), an oral selective vasopressin 2 receptor antagonist, was approved in Japan in December 2010 for the treatment of excess body fluid not responding to loop diuretics and has been established in Japan for the treatment of a volume overload for heart failure (HF) in contrast to the negative evaluation in the USA and EU countries. A recent Japan large-scale survey, which consisted of 257,812 patients hospitalized because of HF between April 2008 and November 2018 in Japan, showed that TLV was prescribed within two days of hospitalization in >50% of HF cases since 2015 [3]. Regarding the short-term or in-hospital effects of TLV, recent randomized control studies have shown that
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
