1
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Wang W, Gao F, He X, Gao Y, Shi L, Liu W, Zhuang X. Efficacy of tolvaptan in postoperative volume therapy for acute Stanford type A aortic dissection. BMC Cardiovasc Disord 2023; 23:95. [PMID: 36803437 PMCID: PMC9942290 DOI: 10.1186/s12872-023-03125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Despite the increasing application of tolvaptan in cardiac surgery, there is no information on the use of tolvaptan in Stanford patients with type A aortic dissection. This study aimed to evaluate the postoperative clinical effects of tolvaptan in patients with type A aortic dissection after tafter surgery. METHODS A retrospective analysis was performed on 45 patients treated for type A aortic dissection in our hospital from 2018 to 2020. These included 21 patients who were treated with tolvaptan (Group T) and 24 patients who received traditional diuretics (Group L). The hospital's electronic health records were used to obtain perioperative data. RESULTS Group T did not differ significantly from Group L in terms of the duration of mechanical ventilation, postoperative blood required, length of catecholamine use, or the amount of intravenous diuretic drugs administered (all P > 0.05). The development of postoperative atrial fibrillation was significantly less in the tolvaptan group (P = 0.023). The urine volumes and change in body weight loss were slightly higher in group T than in group L but the differences were non-significant (P > 0.05). Serum potassium, creatinine, and urea nitrogen levels did not differ between the groups in the week after surgery, At the same time, sodium was significantly higher in the Group T group on day 7 after transfer from the ICU (P = 0.001). In Group L, sodium levels were also elevated by day 7 (P = 0.001). On days 3 and 7, serum creatinine and urea nitrogen levels increased in both groups (both P < 0.05). CONCLUSIONS Both tolvaptan and traditional diuretics were found to be effective and safe for patients with acute Stanford type A aortic dissection. Moreover, tolvaptan may be associated with reducing the incidence of postoperative atrial fibrillation.
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Affiliation(s)
- Wenjun Wang
- grid.452337.40000 0004 0644 5246Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Feng Gao
- grid.452337.40000 0004 0644 5246Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Xuezhi He
- grid.452337.40000 0004 0644 5246Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Yang Gao
- grid.452337.40000 0004 0644 5246Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Lei Shi
- grid.452337.40000 0004 0644 5246Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Wei Liu
- grid.452337.40000 0004 0644 5246Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Xijing Zhuang
- Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, Dalian, China.
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2
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Lee Y, Yoo KD, Baek SH, Kim YG, Kim HJ, Ryu JY, Paek JH, Suh SH, Oh SW, Lee J, Jhee JH, Suh JS, Yang EM, Park YH, Kim YL, Choi M, Oh KH, Kim S. Korean Society of Nephrology 2022 recommendations on controversial issues in diagnosis and management of hyponatremia. Korean J Intern Med 2022; 37:1120-1137. [PMID: 36245341 PMCID: PMC9666265 DOI: 10.3904/kjim.2022.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/06/2022] [Indexed: 11/27/2022] Open
Abstract
The Korean Society for Electrolyte and Blood Pressure Research, in collaboration with the Korean Society of Nephrology, has published a clinical practice guideline (CPG) document for hyponatremia treatment. The document is based on an extensive evidence-based review of the diagnosis, evaluation, and treatment of hyponatremia with the multidisciplinary participation of representative experts in hyponatremia with methodologist support for guideline development. This CPG consists of 12 recommendations (two for diagnosis, eight for treatment, and two for special situations) based on eight detailed topics and nine key questions. Each recommendation begins with statements graded by the strength of the recommendations and the quality of the evidence. Each statement is followed by rationale supporting the recommendations. The committee issued conditional recommendations in favor of rapid intermittent bolus administration of hypertonic saline in severe hyponatremia, the use of vasopressin receptor antagonists in heart failure with hypervolemic hyponatremia, and syndrome of inappropriate antidiuresis with moderate to severe hyponatremia, the individualization of desmopressin use, and strong recommendation on the administration of isotonic fluids as maintenance fluid therapy in hospitalized pediatric patients. We hope that this CPG will provide useful recommendations in practice, with the aim of providing clinical support for shared decision-making to improve patient outcomes.
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Affiliation(s)
- Yeonhee Lee
- Division of Nephrology, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu,
Korea
| | - Kyung Don Yoo
- Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan,
Korea
| | - Seon Ha Baek
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong,
Korea
| | - Yang Gyun Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul,
Korea
| | - Hyo Jin Kim
- Division of Nephrology, Department of Internal Medicine, Pusan National University Hospital, Busan,
Korea
| | - Ji Young Ryu
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong,
Korea
| | - Jin Hyuk Paek
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu,
Korea
| | - Sang Heon Suh
- Division of Nephrology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
| | - Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul,
Korea
| | - Jeonghwan Lee
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul,
Korea
| | - Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Jin-Soon Suh
- Division of Pediatric Nephrology, Department of Pediatrics, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon,
Korea
| | - Eun Mi Yang
- Division of Pediatric Nephrology, Department of Pediatrics, Chonnam National University Hospital, Gwangju,
Korea
| | - Young Ho Park
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Yae Lim Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul,
Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency (NECA), Seoul,
Korea
| | - Kook-Hwan Oh
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Sejoong Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
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3
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Lee Y, Yoo KD, Baek SH, Kim YG, Kim HJ, Ryu JY, Paek JH, Suh SH, Oh SW, Lee J, Jhee JH, Suh JS, Yang EM, Park YH, Kim YL, Choi M, Oh KH, Kim S. Korean Society of Nephrology 2022 Recommendations on controversial issues in diagnosis and management of hyponatremia. Kidney Res Clin Pract 2022; 41:393-411. [PMID: 35919925 PMCID: PMC9346392 DOI: 10.23876/j.krcp.33.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/23/2022] [Indexed: 11/28/2022] Open
Abstract
The Korean Society for Electrolyte and Blood Pressure Research, in collaboration with the Korean Society of Nephrology, has published a clinical practice guideline (CPG) document for hyponatremia treatment. The document is based on an extensive evidence-based review of the diagnosis, evaluation, and treatment of hyponatremia with the multidisciplinary participation of representative experts in hyponatremia with methodologist support for guideline development. This CPG consists of 12 recommendations (two for diagnosis, eight for treatment, and two for special situations) based on eight detailed topics and nine key questions. Each recommendation begins with statements graded by the strength of the recommendations and the quality of the evidence. Each statement is followed by rationale supporting the recommendations. The committee issued conditional recommendations in favor of rapid intermittent bolus administration of hypertonic saline in severe hyponatremia, the use of vasopressin receptor antagonists in heart failure with hypervolemic hyponatremia, and syndrome of inappropriate antidiuresis with moderate to severe hyponatremia, the individualization of desmopressin use, and strong recommendation on the administration of isotonic fluids as maintenance fluid therapy in hospitalized pediatric patients. We hope that this CPG will provide useful recommendations in practice, with the aim of providing clinical support for shared decision-making to improve patient outcomes.
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Affiliation(s)
- Yeonhee Lee
- Division of Nephrology, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Republic of Korea
| | - Kyung Don Yoo
- Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Seon Ha Baek
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Yang Gyun Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyo Jin Kim
- Division of Nephrology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Ji Young Ryu
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Jin Hyuk Paek
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Sang Heon Suh
- Division of Nephrology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jeonghwan Lee
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Soon Suh
- Division of Pediatric Nephrology, Department of Pediatrics, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Mi Yang
- Division of Pediatric Nephrology, Department of Pediatrics, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Young Ho Park
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Yae Lim Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Kook-Hwan Oh
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sejoong Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Correspondence: Sejoong Kim Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173beon-gil, Bundang-gu, Seongnam 13620, Republic of Korea. E-mail:
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4
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Lee Y, Yoo KD, Baek SH, Kim YG, Kim HJ, Ryu JY, Paek JH, Suh SH, Oh SW, Lee J, Jhee JH, Suh JS, Yang EM, Park YH, Kim YL, Choi M, Oh KH, Kim S. Korean Society of Nephrology 2022 Recommendations on controversial issues in diagnosis and management of hyponatremia. Kidney Res Clin Pract 2022. [PMCID: PMC9351400 DOI: 10.23876/j.krcp.33.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Yeonhee Lee
- Division of Nephrology, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Republic of Korea
| | - Kyung Don Yoo
- Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Seon Ha Baek
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Yang Gyun Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyo Jin Kim
- Division of Nephrology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Ji Young Ryu
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Jin Hyuk Paek
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Sang Heon Suh
- Division of Nephrology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jeonghwan Lee
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Soon Suh
- Division of Pediatric Nephrology, Department of Pediatrics, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Mi Yang
- Division of Pediatric Nephrology, Department of Pediatrics, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Young Ho Park
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Yae Lim Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Kook-Hwan Oh
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sejoong Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Correspondence: Sejoong Kim Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173beon-gil, Bundang-gu, Seongnam 13620, Republic of Korea. E-mail:
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Efficacy of tolvaptan on advanced chronic kidney disease with heart failure: a randomized controlled trial. Clin Exp Nephrol 2022; 26:851-858. [PMID: 35471469 PMCID: PMC9385808 DOI: 10.1007/s10157-022-02224-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/04/2022] [Indexed: 11/18/2022]
Abstract
Background Tolvaptan (TLV) is reported to improve diuretic effects in patients with chronic kidney disease (CKD) when furosemide (FUR) is not sufficiently effective. However, it is not clear whether TLV addition is effective for advanced CKD patients with heart failure. Methods An open-label, parallel-group randomized trial was performed. The subjects were 33 patients with CKD stage G3–G5 who had fluid overload despite taking 20–100 mg/day FUR. They were divided into two groups: a group administered 15 mg/day TLV plus their original FUR dose for 7 days (TLV group), and a group administered 120–200 mg/day FUR (i.e., 100 mg/day over their previous dose) for 7 days (FUR group). Results The mean change in urine volume was significantly higher in the TLV group compared to the FUR group (637 ml vs 119 ml; p < 0.05). The difference was greater when the urine osmolality before treatment was high. Serum creatinine was increased only in the FUR group. The incidence of worsening renal function (WRF) was significantly lower in the TLV group (18.8% vs 58.8%; p < 0.05). Serum sodium decreased significantly in the FUR group, but did not change in the TLV group. Conclusions In patients with advanced CKD with fluid overload, the addition of TLV achieved a significantly higher urine volume with less adverse effects on renal function compared with increasing the dose of FUR. The efficacy and safety of TLV were higher in patients who had higher urine osmolality and lower serum sodium before treatment. Clinical trial registration UMIN000014763.
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6
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Temporal Change in Renoprotective Effect of Tolvaptan on Patients with Heart Failure: AURORA Study. J Clin Med 2022; 11:jcm11040977. [PMID: 35207249 PMCID: PMC8879381 DOI: 10.3390/jcm11040977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/03/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
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.
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7
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Lee Y, Yoo KD, Baek SH, Kim YG, Kim HJ, Ryu JY, Paek JH, Suh SH, Oh SW, Lee J, Jhee JH, Suh JS, Yang EM, Park YH, Kim YL, Choi M, Oh KH, Kim S. Korean Society of Nephrology 2022 Recommendations on Controversial Issues in Diagnosis and Management of Hyponatremia. Electrolyte Blood Press 2022; 20:21-38. [DOI: 10.5049/ebp.2022.20.1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/01/2022] [Accepted: 07/02/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Yeonhee Lee
- Division of Nephrology, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University, Gyeonggi-do, Republic of Korea
| | - Kyung Don Yoo
- Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Seon Ha Baek
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Yang Gyun Kim
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, College of Medicine, Seoul, Republic of Korea
| | - Hyo Jin Kim
- Division of Nephrology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Ji Young Ryu
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Jin Hyuk Paek
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Sang Heon Suh
- Division of Nephrology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jeonghwan Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Soon Suh
- Division of Pediatric Nephrology, Department of Pediatrics, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Mi Yang
- Division of Pediatric Nephrology, Department of Pediatrics, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Young Ho Park
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Yae Lim Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Kook-Hwan Oh
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sejoong Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
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Matsumura K, Teranaka W, Taniichi M, Otagaki M, Takahashi H, Fujii K, Yamamoto Y, Nakazawa G, Shiojima I. Differential effect of malnutrition between patients hospitalized with new-onset heart failure and worsening of chronic heart failure. ESC Heart Fail 2021; 8:1819-1826. [PMID: 33655718 PMCID: PMC8120416 DOI: 10.1002/ehf2.13279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/19/2021] [Accepted: 02/11/2021] [Indexed: 12/20/2022] Open
Abstract
Aims We aimed to investigate the differences in the prevalence, severity, and prognostic impact of malnutrition between patients with new‐onset heart failure (HF) and worsening of chronic HF. Methods and results In older (≥60 years) hospitalized patients with acute HF, malnutrition was assessed according to the Geriatric Nutritional Risk Index (GNRI). A score <92 was defined as malnutrition. The primary endpoint was a composite endpoint, including cardiac death or rehospitalization for HF. Among 210 patients, 37% (52/142) of patients with new‐onset HF and 31% (21/68) of patients with worsening of chronic HF had malnutrition (P = 0.41). The GNRI classification was comparable between the two groups. Kaplan–Meier analysis revealed a significant difference in the incidence of the composite endpoint in patients with new‐onset HF (GNRI < 92 vs. GNRI ≥ 92: 50% vs. 32%, P = 0.007), but not in patients with worsening of chronic HF (GNRI < 92 vs. GNRI ≥ 92: 67% vs. 68%, P = 0.91). The adjusted Cox proportional hazards model demonstrated that a GNRI of <92 was an independent prognostic factor for the composite endpoint in patients with new‐onset HF only. Conclusions Among older hospitalized patients with acute HF, the prevalence and severity of malnutrition were comparable between the two categories of patients. Malnutrition was an independent prognostic factor in patients with new‐onset HF, while clinical prognosis was poor in patients with worsening of HF, irrespective of malnutrition. The prognostic impact of malnutrition differs between new‐onset HF and worsening of chronic HF.
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Affiliation(s)
- Koichiro Matsumura
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, 5708507, Japan.,Department of Cardiology, Kindai University, 377-2, Ohno-higashi, Osakasayama, 5898511, Japan
| | - Wakana Teranaka
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, 5708507, Japan
| | - Masanao Taniichi
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, 5708507, Japan
| | - Munemitsu Otagaki
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, 5708507, Japan
| | - Hiroki Takahashi
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, 5708507, Japan
| | - Kenichi Fujii
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, 5708507, Japan
| | - Yoshihiro Yamamoto
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, 5708507, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Kindai University, 377-2, Ohno-higashi, Osakasayama, 5898511, Japan
| | - Ichiro Shiojima
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, 5708507, Japan
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9
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Long-term administration of tolvaptan ameliorates annual decline in estimated glomerular filtration rate in outpatients with chronic heart failure. Heart Vessels 2021; 36:1175-1182. [PMID: 33580283 DOI: 10.1007/s00380-021-01801-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
Protective effects of tolvaptan against worsening renal function in acute heart failure have been shown. However, long-term effects of its agent on renal function remain to be elucidated. The present study investigated retrospectively whether long-term treatment with tolvaptan exerts renoprotective effects in patients with chronic heart failure, by comparing serial changes in estimated glomerular filtration rate (eGFR) for years before and after tolvaptan administration. From 63 outpatients with chronic heart failure taking diuretics including tolvaptan, 34 patients whose eGFR levels were continuously measured for more than 6 months both before and after administration of tolvaptan (average dose, 7.8 mg/day at the end of the follow-up period) were selected as eligible for the present analyses. All eGFR values were separately plotted before and after the initiation of treatment with tolvaptan (except hospitalization periods) along the time course axis and the slope of the linear regression curve was calculated as an annual change in eGFR. The mean follow-up periods before and after tolvaptan administration were 1197 and 784 days (3.3 and 2.1 years), respectively. Changing rates of eGFR per year were significantly ameliorated after treatment with tolvaptan (mean ± SD, - 8.02 ± 9.35 to - 1.62 ± 5.09 mL/min/1.73m2 /year, P = 0.001). In echocardiographic parameters, inferior vena cava (IVC) diameter significantly decreased after tolvaptan administration, and the decrease in IVC diameter was correlated with the improvement of eGFR decline slope after administration of tolvaptan (P = 0.0075). This longitudinal observational study indicated that long-term treatment with tolvaptan ameliorated annual decline in eGFR in outpatients with chronic heart failure. Our findings suggest that tolvaptan has a protective effect against chronically worsening renal function in heart failure patients.
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10
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El‐Shabrawy M, Mishriki A, Attia H, Emad Aboulhoda B, Emam M, Wanas H. Protective effect of tolvaptan against cyclophosphamide-induced nephrotoxicity in rat models. Pharmacol Res Perspect 2020; 8:e00659. [PMID: 32996719 PMCID: PMC7525803 DOI: 10.1002/prp2.659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/08/2020] [Accepted: 08/18/2020] [Indexed: 12/18/2022] Open
Abstract
Cyclophosphamide (CP) is a chemotherapeutic agent which is extensively used in the treatment of multiple neoplastic and nonneoplastic diseases like breast cancer, lymphomas, systemic lupus erythematosus, and multiple sclerosis. Dose-limiting side effects, mainly nephrotoxicity is a major problem hindering its use in the clinical practice. CP induces nephrogenic syndrome of inappropriate antidiuresis mostly via the activation of arginine vasopressin V2 receptors. Moreover, CP produces reactive metabolites which is responsible for augmentation of lipid peroxidation and oxidative stress. Tolvaptan (TOL) is a selective vasopressin V2 receptor antagonist used in the treatment of clinically significant hyponatremia, volume overload in heart failure, and liver cirrhosis with edema. The present study aimed to investigate the potential protective effect of TOL in CP-induced nephrotoxicity. Twenty-four adult male albino rats were randomly divided into four groups: the control group, TOL group that treated daily with tolvaptan (10 mg/kg/d, orally), CP group where CP was administered intraperitoneally 75 mg/kg on days 3, 4, 5, 19, 20, and 21 of study, and the CP + TOL group where animals were treated with TOL daily with (10 mg/kg/d, orally) for 22 days with concomitant administration of CP as described before. Coadministration of TOL with CP induces significant improvement in the level of urine volume, serum Na+, serum osmolarity, urinary creatinine, and free water clearance in addition to significant reduction of body weight, serum creatinine, urea, serum K+, blood pressure, urine osmolarity, and the fractional excretion of sodium as compared to CP-treated group. In addition, coadministration of TOL significantly reduced MDA, the marker of lipid peroxidation, and different pro-inflammatory cytokines. Histopathological changes showed improvement in the signs of nephrotoxicity with the coadministration of TOL. Also, co-treatment with TOL significantly decreased the level of markers of apoptosis as caspase-3 and Bax with increased expression of antiapoptotic Bcl-2 in renal tissue as compared to CP-treated group.
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Affiliation(s)
- Mohamed El‐Shabrawy
- Department of Medical PharmacologyFaculty of MedicineCairo UniversityCairoEgypt
| | - Amal Mishriki
- Department of Medical PharmacologyFaculty of MedicineCairo UniversityCairoEgypt
| | - Hisham Attia
- Department of Medical PharmacologyFaculty of MedicineCairo UniversityCairoEgypt
| | - Basma Emad Aboulhoda
- Department of Anatomy and EmbryologyFaculty of medicineCairo UniversityCairoEgypt
| | - Mohamed Emam
- Department of HistopathologyFaculty of MedicineCairo UniversityCairoEgypt
| | - Hanaa Wanas
- Department of Medical PharmacologyFaculty of MedicineCairo UniversityCairoEgypt
- Department of Toxicology and PharmacologyFaculty of PharmacyTaibah UniversityMadinahSaudi Arabia
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Kin H, Matsumura K, Yamamoto Y, Fujii K, Otagaki M, Takahashi H, Park H, Yoshioka K, Yokoi M, Sugiura T, Shiojima I. Renoprotective effect of tolvaptan in patients with new-onset acute heart failure. ESC Heart Fail 2020; 7:1764-1770. [PMID: 32383323 PMCID: PMC7373889 DOI: 10.1002/ehf2.12738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 12/31/2022] Open
Abstract
AIMS Although tolvaptan has been reported to prevent worsening renal function (WRF) in patients with advanced acute heart failure (AHF), evidence regarding the effect of tolvaptan on renal function in patients with new-onset AHF is not available. This study aimed to investigate the renoprotective effect of tolvaptan in patients hospitalized with new-onset AHF. METHODS AND RESULTS A total of 122 consecutive patients hospitalized with new-onset AHF between May 2015 and December 2018 were retrospectively evaluated. WRF was defined as an absolute increase in serum creatinine ≥0.3 mg/dL (≥26.4 μmol/L) within 48 h or a 1.5-fold increase in serum creatinine after hospitalization. The furosemide group (n = 75) and the tolvaptan add-on group (n = 47) were compared. The tolvaptan group consists of patients who received tolvaptan as an individual physicians' decision. The incidence of WRF was significantly lower in the tolvaptan add-on group (8.5%) than in the furosemide group (24.0%, P = 0.03). Multivariate logistic regression analysis revealed that tolvaptan treatment was an independent variable related to the prevention of WRF [odds ratio (OR), 0.20; 95% confidence interval (CI), 0.05-0.85]. Furthermore, subgroup analysis revealed a more favourable effect of tolvaptan in patients with serum creatinine ≥1.1 mg/dL on admission (OR, 0.23; 95% CI, 0.06-0.98) and an ejection fraction <50% (OR, 0.19; 95% CI, 0.04-0.90). CONCLUSIONS A lower incidence of WRF was observed in patients with new-onset AHF who were treated with the tolvaptan add-on therapy, specifically those with left ventricular systolic dysfunction and renal impairment on admission.
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Affiliation(s)
- Hiromi Kin
- Department of Cardiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Koichiro Matsumura
- Department of Cardiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Yoshihiro Yamamoto
- Department of Cardiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Kenichi Fujii
- Division of Cardiology, Department of Medicine II, Kansai Medical University, Osaka, Japan
| | - Munemitsu Otagaki
- Department of Cardiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Hiroki Takahashi
- Department of Cardiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Haengnam Park
- Department of Cardiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Kei Yoshioka
- Department of Cardiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Mitsuru Yokoi
- Department of Cardiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Tetsuro Sugiura
- Department of Cardiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Ichiro Shiojima
- Division of Cardiology, Department of Medicine II, Kansai Medical University, Osaka, Japan
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