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Tzoulis P, Kaltsas G, Baldeweg SE, Bouloux PM, Grossman AB. Tolvaptan for the treatment of the syndrome of inappropriate antidiuresis (SIAD). Ther Adv Endocrinol Metab 2023; 14:20420188231173327. [PMID: 37214762 PMCID: PMC10192810 DOI: 10.1177/20420188231173327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/15/2023] [Indexed: 05/24/2023] Open
Abstract
The syndrome of inappropriate antidiuresis (SIAD), the commonest cause of hyponatraemia, is associated with significant morbidity and mortality. Tolvaptan, an oral vasopressin V2-receptor antagonist, leads through aquaresis to an increase in serum sodium concentration and is the only medication licenced in Europe for the treatment of euvolaemic hyponatraemia. Randomised controlled trials have shown that tolvaptan is highly efficacious in correcting SIAD-related hyponatraemia. Real-world data have confirmed the marked efficacy of tolvaptan, but they have also reported a high risk of overly rapid sodium increase in patients with a very low baseline serum sodium. The lower the baseline serum sodium, the higher the tolvaptan-induced correction rate occurs. Therefore, a lower starting tolvaptan dose of 7.5 mg has been evaluated in small cohort studies, demonstrating its efficacy, but it still remains unclear as to whether it can reduce the risk of overcorrection. Most international guidelines, except for the European ones, recommend tolvaptan as second-line treatment for SIAD after fluid restriction. However, the risk of unduly rapid sodium correction in combination with its high cost have limited its routine use. Prospective controlled studies are warranted to evaluate whether tolvaptan-related sodium increase can improve patient-related clinical outcomes, such as mortality and length of hospital stay in the acute setting or neurocognitive symptoms and quality of life in the chronic setting. In addition, the potential role of a low tolvaptan starting dose needs to be further explored. Until then, tolvaptan should mainly be used as second-line treatment for SIAD, especially when there is a clinical need for prompt restoration of normonatraemia. Tolvaptan should be used with specialist input according to a structured clinical pathway, including rigorous monitoring of electrolyte and fluid balance and, if needed, implementation of appropriate measures to prevent, or when necessary reverse, overly rapid hyponatraemia correction.
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Affiliation(s)
| | - Gregory Kaltsas
- First Department of Propaedeutic and Internal
Medicine, Laiko University Hospital, National and Kapodistrian University of
Athens, Athens, Greece
| | - Stephanie E. Baldeweg
- Department of Diabetes & Endocrinology,
University College London Hospitals NHS Foundation Trust, London, UK
- Division of Medicine, University College
London, London, UK
| | | | - Ashley B. Grossman
- Green Templeton College, University of Oxford,
Oxford, UK
- Neuroendocrine Tumour Unit, Royal Free
Hospital, London, UK
- Centre for Endocrinology, Barts and the London
School of Medicine, Queen Mary University of London, London, UK
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2
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Hachiya R, Mochizuki Y, Shibakai M, Omomo Y, Kuroki Y, Endo Y, Ichikawa S, Miyazaki H, Chino S, Toyosaki E, Ota M, Fukuoka H, Shinke T. Right ventricular contractility affects the clinical efficacy of add-on tolvaptan following hospitalization for heart failure in patients with significant tricuspid regurgitation. Heart Vessels 2021; 37:755-764. [PMID: 34677658 DOI: 10.1007/s00380-021-01973-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/15/2021] [Indexed: 11/24/2022]
Abstract
Tricuspid regurgitation (TR) is a common condition that is independently associated with high mortality rates in patients with heart failure (HF). Several studies have demonstrated the clinical efficacy of add-on tolvaptan in patients hospitalized for HF. However, the effects of add-on tolvaptan in patients with significant TR are less well understood. Among the patients with moderate-to-severe TR assessed by transthoracic echocardiography during hospitalization for congestive HF, 39 patients who could complete the clinical course after starting add-on tolvaptan were included in the study. Rehospitalization due to HF and cardiac death were defined as adverse cardiac events in this study. We investigated the presence or absence of cardiac events within 2 years following the introduction of tolvaptan and evaluated echocardiographic functional parameters associated with cardiac events. The average patient age was 75 ± 14 years, and 23 patients (59%) experienced adverse cardiac events within 2 years after add-on tolvaptan administration. Serum creatinine (mg/dL) and brain natriuretic peptide (pg/mL) concentrations at discharge were significantly higher in patients with cardiac events than in those without cardiac events {1.48 [1.02-1.58] vs. 1.07 [0.79-1.41], p = 0.03; 526 [414-1044] vs. 185 [104-476], p = 0.01, respectively}. The presence or absence of past hospitalization for HF was also significantly higher in the event-positive group compared to event-free group (78 vs. 44%, p = 0.04). Comparison of echocardiographic parameters revealed that patients with cardiac events had a significantly lower left ventricular ejection fraction (40 ± 16 vs. 49 ± 15%, p = 0.049) and lower right ventricular fractional area change (RVFAC) (35 ± 12 vs. 45 ± 10%, p = 0.008) than those without cardiac events. Multiple logistic regression analysis revealed that RVFAC and past hospitalization for HF were independently associated with cardiac events following the introduction of tolvaptan (odds ratio, 0.934 and 4.992; p = 0.048 and 0.04, respectively). Right ventricular contractility as well as past history of admission for HF, left ventricular ejection fraction, renal function, and brain natriuretic peptide level at discharge may reflect the clinical outcomes after HF hospitalization in patients with significant TR who were treated with tolvaptan.
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Affiliation(s)
- Rumi Hachiya
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Yasuhide Mochizuki
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
| | - Mina Shibakai
- Ultrasound Examination Center, Showa University Hospital, Tokyo, Japan
| | - Yui Omomo
- Ultrasound Examination Center, Showa University Hospital, Tokyo, Japan
| | - Yui Kuroki
- Ultrasound Examination Center, Showa University Hospital, Tokyo, Japan
| | - Yukiko Endo
- Ultrasound Examination Center, Showa University Hospital, Tokyo, Japan
| | - Saaya Ichikawa
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Haruka Miyazaki
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Saori Chino
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Eiji Toyosaki
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Masashi Ota
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Hiroto Fukuoka
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
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3
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Ong LT. Evidence based review of management of cardiorenal syndrome type 1. World J Methodol 2021; 11:187-198. [PMID: 34322368 PMCID: PMC8299910 DOI: 10.5662/wjm.v11.i4.187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 05/09/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiorenal syndrome (CRS) type 1 is the development of acute kidney injury in patients with acute decompensated heart failure. CRS often results in prolonged hospitalization, a higher rate of rehospitalization, high morbidity, and high mortality. The pathophysiology of CRS is complex and involves hemodynamic changes, neurohormonal activation, hypothalamic-pituitary stress reaction, inflammation, and infection. However, there is limited evidence or guideline in managing CRS type 1, and the established therapeutic strategies mainly target the symptomatic relief of heart failure. This review will discuss the strategies in the management of CRS type 1. Six clinical studies have been included in this review that include different treatment strategies such as nesiritide, dopamine, levosimendan, tolvaptan, dobutamine, and ultrafiltration. Treatment strategies for CRS type 1 are derived based on the current literature. Early recognition and treatment of CRS can improve the outcomes of the patients significantly.
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Affiliation(s)
- Leong Tung Ong
- Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Wilayah Persekutuan Kuala Lumpur, Malaysia
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4
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Suwanto D, Dewi IP, Fagi RA. Hyponatremia in heart failure: not just 135 to 145. J Basic Clin Physiol Pharmacol 2021; 33:381-388. [PMID: 34134181 DOI: 10.1515/jbcpp-2020-0399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 06/01/2021] [Indexed: 01/21/2023]
Abstract
One of the most frequent in-hospital electrolyte disturbances is hyponatremia. Hyponatremia in heart failure (HF) is mainly associated with hypervolemia resulting from activation of baroreceptor-mediated hormones, such as arginine vasopressin (AVP), renin-angiotensin-aldosterone system, and catecholamines. Various electrolyte imbalance can occur as heart failure progress. The goal of this review was to outline the current literature on hyponatremia in HF patients.
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Affiliation(s)
- Denny Suwanto
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Cardiology and Vascular Medicine Department, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Ivana Purnama Dewi
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Cardiology and Vascular Medicine Department, Dr. Soetomo General Hospital, Surabaya, Indonesia.,Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia
| | - Rosi Amrilla Fagi
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Cardiology and Vascular Medicine Department, Dr. Soetomo General Hospital, Surabaya, Indonesia
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5
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Tolvaptan Response in a Hyponatremic Newborn with Syndrome of Inappropriate Secretion of Antidiuretic Hormone. Case Rep Pediatr 2021; 2021:9920817. [PMID: 34094612 PMCID: PMC8137302 DOI: 10.1155/2021/9920817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/07/2021] [Indexed: 11/25/2022] Open
Abstract
The use of tolvaptan to treat both euvolemic and hypervolemic hyponatremia has rapidly increased in recent years. However, data on its effects on children, especially newborns and infants, are limited. Here, we present a newborn who developed syndrome of inappropriate secretion of antidiuretic hormone following an intracranial hematoma drainage operation who was unresponsive to conventional treatments. The infant was successfully treated with tolvaptan, a competitive inhibitor of the vasopressin V2 receptor.
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Ikeda Y, Tsutsui K, Yamada Y, Kato R, Muramatsu T, Senbonmatsu T. Relationship between Soluble (pro)Renin Receptor and Renin Activity in Patients with Severe Heart Failure. J Clin Med 2020; 9:E4110. [PMID: 33352807 PMCID: PMC7765833 DOI: 10.3390/jcm9124110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/07/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022] Open
Abstract
The (pro)renin receptor ((P)RR), which evokes renin activity with prorenin, is secreted extracellularly as soluble (P)RR (s(P)RR) and may participate in tissue renin-angiotensin system (RAS) activity in severe heart failure (HF) patients. The aim of this study was to determine whether s(P)RR is an adequate marker in severe HF patients treated with RAS inhibitors, beta-blockers, and tolvaptan. We enrolled 11 patients with severe HF between May 2013 and June 2014. First of all, furosemide of all patients was changed to tolvaptan with hydrochlorothiazide and then the treatment had been changed according to the patient's condition. After 1, 3, 6, and 12 months, the variance of s(P)RR, plasma renin activity (PRA), plasma renin concentration (PRC), brain natriuretic peptide (BNP) and their association was investigated. Furosemide was restarted in five patients and two patients suffered cardiac death. PRA/PRC and s(P)RR were unchanged (PRA: 10.7 ± 13.9 to 12.8 ± 8.5 ng/mL/h; PRC: 347.1 ± 577.5 to 148.3 ± 123.8 pg/mL; s(P)RR: 28.2 ± 19.3 to 33.4 ± 22.4 ng/mL) and had no significant correlations (PRA and s(P)RR: p = 0.36; PRC and s(P)RR: p = 0.35). There was a significant positive correlation with a high correlation coefficient (CC) between PRA and PRC (p < 0.0001, CC = 0.76), and a negative correlation with weak CC between BNP and s(P)RR (p = 0.01, CC = -0.45). In conclusion, s(P)RR was always high and had no correlations with disease state and PRA/PRC in severe HF patients.
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Affiliation(s)
- Yoshifumi Ikeda
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan; (K.T.); (Y.Y.); (R.K.); (T.M.); (T.S.)
| | - Kenta Tsutsui
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan; (K.T.); (Y.Y.); (R.K.); (T.M.); (T.S.)
| | - Yoshihiro Yamada
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan; (K.T.); (Y.Y.); (R.K.); (T.M.); (T.S.)
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan; (K.T.); (Y.Y.); (R.K.); (T.M.); (T.S.)
| | - Toshihiro Muramatsu
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan; (K.T.); (Y.Y.); (R.K.); (T.M.); (T.S.)
| | - Takaaki Senbonmatsu
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan; (K.T.); (Y.Y.); (R.K.); (T.M.); (T.S.)
- Department, Research Administration Center, Saitama Medical University, Saitama 350-1298, Japan
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7
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Lopez E, Fukuda S, Modis K, Fujiwara O, Enkhtaivan B, Trujillo-Abarca R, Ihara K, Lima-Lopez F, Perez-Bello D, Szabo C, Prough DS, Enkhbaatar P. Arginine vasopressin receptor 2 activation promotes microvascular permeability in sepsis. Pharmacol Res 2020; 163:105272. [PMID: 33160069 DOI: 10.1016/j.phrs.2020.105272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 12/16/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) sepsis is a severe condition associated with vascular leakage and poor prognosis. The hemodynamic management of sepsis targets hypotension, but there is no specific treatment available for vascular leakage. Arginine vasopressin (AVP) has been used in sepsis to promote vasoconstriction by activating AVP receptor 1 (V1R). However, recent evidence suggests that increased fluid retention may be associated with the AVP receptor 2 (V2R) activation worsening the outcome of sepsis. Hence, we hypothesized that the inhibition of V2R activation ameliorates the severity of microvascular hyperpermeability during sepsis. The hypothesis was tested using a well-characterized and clinically relevant ovine model of MRSA pneumonia/sepsis and in vitro assays of human lung microvascular endothelial cells (HMVECs). in vivo experiments demonstrated that the treatment of septic sheep with tolvaptan (TLVP), an FDA-approved V2R antagonist, significantly attenuated the sepsis-induced fluid retention and markedly reduced the lung water content. These pathological changes were not affected by the treatment with V2R agonist, desmopressin (DDAVP). Additionally, the incubation of cultured HMVECs with DDAVP, and DDAVP along with MRSA significantly increased the paracellular permeability. Finally, both the DDAVP and MRSA-induced hyperpermeability was significantly attenuated by TLVP. Subsequent protein and gene expression assays determined that the V2R-induced increase in permeability is mediated by phospholipase C beta (PLCβ) and the potent permeability factor angiopoietin-2. In conclusion, our results indicate that the activation of the AVP-V2R axis is critical in the pathophysiology of severe microvascular hyperpermeability during Gram-positive sepsis. The use of the antagonist TLVP should be considered as adjuvant treatment for septic patients. The results from this clinically relevant animal study are highly translational to clinical practice.
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Affiliation(s)
- Ernesto Lopez
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Satoshi Fukuda
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Katalin Modis
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA; Department of Surgery, University of Texas Medical Branch Galveston, TX, USA
| | - Osamu Fujiwara
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Baigal Enkhtaivan
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Raul Trujillo-Abarca
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Koji Ihara
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA; Department of Plastic and Reconstructive Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Francisco Lima-Lopez
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA; Department of Surgery, University of Texas Medical Branch Galveston, TX, USA
| | - Dannelys Perez-Bello
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Csaba Szabo
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA; Department of Pharmacology, University of Fribourg, Fribourg, Switzerland
| | - Donald S Prough
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Perenlei Enkhbaatar
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA.
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8
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Nishi H. Advent of New perioperative care for fluid management after cardiovascular surgery: A review of current evidence. J Cardiol 2020; 75:606-613. [DOI: 10.1016/j.jjcc.2019.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/04/2019] [Accepted: 12/11/2019] [Indexed: 12/17/2022]
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9
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Packer M. Lessons learned from the DAPA-HF trial concerning the mechanisms of benefit of SGLT2 inhibitors on heart failure events in the context of other large-scale trials nearing completion. Cardiovasc Diabetol 2019; 18:129. [PMID: 31585532 PMCID: PMC6778368 DOI: 10.1186/s12933-019-0938-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 09/27/2019] [Indexed: 02/08/2023] Open
Abstract
Four large-scale trials in type 2 diabetes have shown that sodium-glucose cotransporter 2 (SGLT2) inhibitors prevent the occurrence of serious heart failure events. Additionally, the DAPA-HF trial demonstrated a benefit of dapagliflozin to reduce major adverse outcomes in patients with established heart failure with a reduced ejection fraction. The trial sheds light on potential mechanisms. In DAPA-HF, the benefits of dapagliflozin on heart failure were seen to a similar extent in both patients with or without diabetes, thus undermining the hypothesis that these drugs mitigate glycemia-related cardiotoxicity. The action of SGLT2 inhibitors to promote ketogenesis is also primarily a feature of the action of these drugs in patients with diabetes, raising doubts that enhanced ketogenesis contributes to the benefit on heart failure. Also, dapagliflozin does not have a meaningful effect to decrease circulating natriuretic peptides, and it did not potentiate the actions of diuretics in DAPA-HF; moreover, intensification of diuretics therapy does not reduce cardiovascular death, questioning a benefit of SGLT2 inhibitors that is mediated by an action on renal sodium excretion. Finally, although hematocrit increases with SGLT2 inhibitors might favorably affect patients with coronary artery disease, in DAPA-HF, the benefit of dapagliflozin was similar in patients with or without an ischemic cardiomyopathy; furthermore, increases in hematocrit do not favorably affect the clinical course of patients with heart failure. Therefore, the results of DAPA-HF do not support many currently-held hypotheses about the mechanism of action of SGLT2 inhibitors in heart failure. Ongoing trials are likely to provide further insights.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, 621N. Hall Street, Dallas, TX, 75226, USA. .,Imperial College, London, UK.
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10
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Tanaka T, Kawana M, Kohsaka S. Interpreting the evidence from tolvaptan clinical trials. J Cardiol 2019; 74:195. [DOI: 10.1016/j.jjcc.2019.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 02/28/2019] [Indexed: 11/16/2022]
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Harada D, Asanoi H, Noto T, Takagawa J. Prominent 'Y' descent is an ominous sign of a poorer prognosis in heart failure with preserved ejection fraction. ESC Heart Fail 2019; 6:799-808. [PMID: 31111677 PMCID: PMC6676302 DOI: 10.1002/ehf2.12460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/25/2019] [Accepted: 04/30/2019] [Indexed: 11/08/2022] Open
Abstract
AIMS The heterogeneity of heart failure with preserved ejection fraction (HFpEF) represents different pathophysiological paths by which individual patients develop heart failure. The deterioration mechanisms are considered to be mainly left ventricular diastolic dysfunction, right ventricular (RV) systolic function, and RV afterload. It is unclear whether RV distensibility affects the deterioration of HFpEF. Our study aimed to clarify whether impaired RV distensibility is associated with the deterioration of HFpEF. METHODS AND RESULTS We retrospectively enrolled 322 patients with HFpEF and examined their echocardiography results, electrocardiograms, phonocardiograms, and jugular venous pulse waves. Using signal-processing techniques, the prominent 'Y' descent of the jugular venous waveform was detected as an established haemodynamic sign of a less-distensible right ventricle. We defined cardiovascular events of HFpEF as follows: sudden death, death from heart failure, or hospitalization for HFpEF. During a mean follow-up period of 33 ± 20 months, 73 patients had cardiovascular events of HFpEF. The prevalence of a less-distensible right ventricle and the variables of RV systolic pressure were independent risk factors for cardiovascular events (hazard ratio, 2.046, P = 0.005, and hazard ratio, 1.032 per 1 mmHg, P = 0.002, respectively). The event-free rate of HFpEF was the lowest for HFpEF with a less-distensible right ventricle and elevated RV systolic pressure (≥35 mmHg) (P for trend <0.001). CONCLUSIONS A less-distensible right ventricle and elevated RV systolic pressure were found to be closely associated with the deterioration of HFpEF. Assessment of a less-distensible right ventricle may help to stratify patients and improve therapeutic strategies for HFpEF.
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Affiliation(s)
- Daisuke Harada
- The Cardiology Division, Imizu Municipal Hospital, Toyama, Japan
| | - Hidetsugu Asanoi
- Department of Chronic Heart Failure Management, Global Center for Medical Engineering and Informatics, Osaka University, Osaka, Japan
| | - Takahisa Noto
- The Cardiology Division, Imizu Municipal Hospital, Toyama, Japan
| | - Junya Takagawa
- The Cardiology Division, Imizu Municipal Hospital, Toyama, Japan
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12
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Ali Y, Dohi K, Okamoto R, Katayama K, Ito M. Novel molecular mechanisms in the inhibition of adrenal aldosterone synthesis: Action of tolvaptan via vasopressin V 2 receptor-independent pathway. Br J Pharmacol 2019; 176:1315-1327. [PMID: 30801659 DOI: 10.1111/bph.14630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 01/31/2019] [Accepted: 02/05/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE We investigated the inhibitory effect and associated molecular mechanisms of tolvaptan on angiotensin II (AngII)-induced aldosterone production in vitro and in vivo. EXPERIMENTAL APPROACH In vitro, H295R human adrenocarcinoma cells were incubated with 1 μmol·L-1 arginine vasopressin (AVP) or dDAVP, or tolvaptan (0.1, 1, and 3 μmol·L-1 ) in the presence and absence of 100 nmol·L-1 of AngII. In vivo, Sprague-Dawley rats were treated with tolvaptan 0.05% in the diet for 6 days in the presence and absence of 200 pmol·min-1 AngII. KEY RESULTS Tolvaptan suppressed AngII-induced aldosterone production in a dose-dependent manner in H295R cells, whereas neither AVP nor dDAVP in the presence or absence of AngII altered aldosterone production, suggesting the vasopressin V2 receptor was not involved in the inhibitory effect of tolvaptan on aldosterone synthesis. In addition, tolvaptan inhibited the AngII-induced increase in aldosterone synthase (CYP11B2) protein levels without suppressing CYP11B2 mRNA expression. Notably, tolvaptan increased the levels of unfolded protein response (UPR) marker DDIT3 and eIF2α phosphorylation (a UPR-induced event), which could block the translation of CYP11B2 mRNA into protein and thereby inhibit aldosterone production. In vivo, tolvaptan significantly inhibited AngII-induced increases in serum and adrenal aldosterone levels and CYP11B2 protein levels. This anti-aldosterone effect was associated with a reduction in the elevated systolic and diastolic BP. CONCLUSIONS AND IMPLICATIONS Tolvaptan inhibited AngII-stimulated aldosterone production via a V2 receptor-independent pathway, which can counteract or even surpass its potential activating effect of diuresis-induced aldosterone secretion in certain aldosterone-mediated pathological conditions.
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Affiliation(s)
- Yusuf Ali
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ryuji Okamoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kan Katayama
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
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13
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Gao WQ, Meng XD, Sun Z. Efficacy of tolvaptan for chronic heart failure: Study protocol for a systematic review of randomized controlled trial. Medicine (Baltimore) 2019; 98:e14540. [PMID: 30762795 PMCID: PMC6408044 DOI: 10.1097/md.0000000000014540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The protocol of this study will be proposed for systematic evaluation of the efficacy and safety of tolvaptan in the treatment of chronic heart failure (CHF). METHODS We will retrieve the following electronic databases for randomized controlled trials assessing the efficacy of tolvaptan in patients with CHF: PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Information, and Wanfang Data. Each database will be retrieved from inception to February 1, 2019 without any limitations. The entire process of study selection, data extraction, and methodological quality evaluation will be conducted by 2 independent authors. RESULTS The protocol of this proposed study will compare the efficacy and safety of tolvaptan in the treatment of patients with CHF. The outcomes will include all-cause mortality, change in body weight, urine output, change in serum sodium; and incidence of all adverse events. CONCLUSION The findings of this proposed study will summarize the current evidence of tolvaptan for CHF. ETHICS AND DISSEMINATION All data used in this systematic review will be collected from the previous published trials. Thus, no research ethics approval is needed for this study. The findings of this study will be published at a peer-reviewed journal. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019120818.
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Nakano Y, Mizuno T, Niwa T, Mukai K, Wakabayashi H, Watanabe A, Ando H, Takashima H, Murotani K, Waseda K, Amano T. Impact of Continuous Administration of Tolvaptan on Preventing Medium-Term Worsening Renal Function and Long-Term Adverse Events in Heart Failure Patients with Chronic Kidney Disease. Int Heart J 2018; 59:105-111. [DOI: 10.1536/ihj.16-625] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Toru Niwa
- Department of Cardiology, Aichi Medical University
| | | | | | | | | | | | - Kenta Murotani
- Division of Biostatistics, Clinical Research Center, Aichi Medical University
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Abstract
The vasopressin type 2 receptor antagonist tolvaptan (TLV) is available to treat congestion in patients with heart failure. However, there is paucity of evidence guiding its use, and lack of evidence of its long-term efficacy. Our objectives are to perform a systematic review of studies examining the effects of TLV in patients with heart failure; and a quantitative meta-analysis comparing primary and secondary outcomes between TLV and placebo. Only double-blinded randomized controlled trials, with no restriction on the language or the time of publication, were included. Our main outcome measures were all-cause mortality, change in body weight, change in urine volume, and change in serum sodium. Extracted summary estimates included mean difference and SD for change in body weight, change in urine volume and change in serum sodium levels, and hazard ratio with 95% confidence interval for all-cause mortality. We found 8 double-blinded randomized controlled trials, seven of which were included in this meta-analysis. Assessment of risk of bias was conducted by investigating random sequence generation, allocation concealment, blinding, completeness of outcome data, and potential for selective reporting. We found no evidence of significant bias. TLV showed benefits in reducing body weight, increasing urine volume, and increasing serum sodium. No reduction in mortality was detected. However, the subgroup of patients with hyponatremia might have better mortality outcome with TLV. TLV seemed to be safe, as it did not cause worsening of the renal function or hypotension. In conclusion, a meta-analysis of the published literature suggests short-term benefits of TLV. However, the impact on mortality is inconclusive.
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Kogure T, Jujo K, Hamada K, Saito K, Hagiwara N. Good response to tolvaptan shortens hospitalization in patients with congestive heart failure. Heart Vessels 2017; 33:374-383. [PMID: 29128962 DOI: 10.1007/s00380-017-1072-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Abstract
Tolvaptan has been gradually spread to use as a potent diuretic for congestive heart failure in the limited country. However, the response to this aquaretic drug still is unpredictable. A total of 92 patients urgently hospitalized due to congestive heart failure and treated with tolvaptan in addition to standard treatment was retrospectively analyzed. Responder of tolvaptan treatment was defined as a patient with peak negative fluid balance greater than 500 mL/day, and clinical profiles were compared between 76 responders and 16 non-responders. Responders started to increase daily urine volume (UV) from Day 1 through Day 3. In contrast, non-responders showed no significant increase in daily UV from the baseline up to Day 5. Time between admission and tolvaptan administration was shorter in responders, even without statistical significance (3.3 vs. 4.6 days, p = 0.053). Multivariate analysis revealed that blood urea nitrogen (BUN) [cutoff: 34 mg/dL, odds ratio (OR) 9.0, 95% confidence interval (CI) 1.42-57.3, p < 0.01] and plasma renin activity (PRA) (cutoff: 4.7 ng/mL/h, OR 6.1, 95% CI 1.01-36.4, p < 0.01) at baseline were independent predictors for tolvaptan responsiveness. It suggests that renal perfusion may affect tolvaptan-induced UV. Finally, durations of stay in intensive care unit and total hospitalization were significantly shorter in responders (median: 6.0 vs. 13.0 days, p = 0.022; 15.0 vs. 25.0 days, p = 0.016, respectively). Responders of tolvaptan have lower BUN and renin activity at baseline, and shorten hospitalization period. Trial Registration The study was registered at University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) with the identifier UMIN000023594. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000024988.
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Affiliation(s)
- Tomohito Kogure
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Kentaro Jujo
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-0054, Japan.
| | - Kazuyuki Hamada
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Katsumi Saito
- Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-0054, Japan
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Kiuchi S, Hisatake S, Kabuki T, Oka T, Dobashi S, Fujii T, Ikeda T. The relationship between the time until commencement of tolvaptan and the length of hospital stay in heart failure patients. Heart Vessels 2017; 33:367-373. [DOI: 10.1007/s00380-017-1067-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/13/2017] [Indexed: 11/28/2022]
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18
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Inomata T, Ikeda Y, Kida K, Shibagaki Y, Sato N, Kumagai Y, Shinagawa H, Ako J, Izumi T. Effects of Additive Tolvaptan vs. Increased Furosemide on Heart Failure With Diuretic Resistance and Renal Impairment - Results From the K-STAR Study. Circ J 2017; 82:159-167. [PMID: 28835586 DOI: 10.1253/circj.cj-17-0179] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND , were randomized into 2 groups and administered either ≤15 mg/day additive tolvaptan (TLV) or ≤40 mg/day increased FUR for 7 days. Changes in urine volume between baseline and mean urine volume during treatment were significantly higher in the TLV than FUR group (P=0.0003). Although there was no significant decrease in body weight or improved signs and symptoms of congestion between the 2 groups, the increase in serum creatinine on Day 7 from baseline was significantly smaller in the TLV than FUR group (P=0.038). Multiple logistic regression analysis revealed that additive TLV (odds ratio 0.157, 95% confidence interval 0.043-0.605, P=0.001) was an independent clinical factor for improved renal function during treatment compared with increased FUR. CONCLUSIONS In HF patients with residual congestion and renal dysfunction refractory to standard therapy, additive TLV increased urine volume without further renal impairment compared with patients who received an increased dose of FUR.
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Affiliation(s)
- Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital
| | - Yuki Ikeda
- Department of Cardiovascular Medicine, Kitasato University
| | - Keisuke Kida
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Naoki Sato
- Internal Medicine and Cardiology, Nippon Medical School Musashi-Kosugi Hospital
| | - Yuji Kumagai
- Kitasato Academic Research Organization, Kitasato University
| | | | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University
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Ikeda S, Ohshima K, Miyazaki S, Kadota H, Shimizu H, Ogimoto A, Hamada M. Impact of chronic kidney disease on the diuretic response of tolvaptan in acute decompensated heart failure. ESC Heart Fail 2017; 4:614-622. [PMID: 29154417 PMCID: PMC5695178 DOI: 10.1002/ehf2.12190] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 05/30/2017] [Accepted: 06/02/2017] [Indexed: 12/16/2022] Open
Abstract
Aim This study investigated the relationship between the initial diuretic response to tolvaptan and clinical predictors for tolvaptan responders in patients with acute decompensated heart failure (ADHF). Methods and results Patients (153) with ADHF (clinical scenario 2 or 3 with signs of fluid retention) who were administered tolvaptan were enrolled. Tolvaptan (15 or 7.5 mg) was administered for at least 7 days to those patients in whom fluid retention was observed even after standard treatment. The maximum urine volume immediately after tolvaptan administration showed good correlations with the ejection fraction and estimated glomerular filtration rate that were independent predictors of the urine volume (UV) responders (≥1500 mL increase in urine volume). The diuretic response (in terms of maximum diuresis) diminished with advancing chronic kidney disease (CKD) stage and concomitant deterioration of the renal function. Furthermore, advanced CKD was a significant negative predictor for the body weight (BW) responders (2.0% decrease in the body weight within 1 week after starting tolvaptan). As compared with non‐CKD, the presence of advanced CKD predicts poor diuretic response for both UV and BW responders. Conclusions The diuretic response following tolvaptan administration gradually diminished with progressive deterioration of the CKD stage. Worsening renal function was not observed. Tolvaptan is effective in treating CS2 or CS3 ADHF patients who present fluid retention and congestion, suggesting its potential efficacy for fluid management in the ADHF patients with CKD without worsening the renal function.
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Affiliation(s)
- Shuntaro Ikeda
- Department of Cardiology, Uwajima City Hospital, 1-1, Goten-machi, Uwajima, Ehime, 798-8510, Japan
| | - Kiyotaka Ohshima
- Department of Cardiology, Uwajima City Hospital, 1-1, Goten-machi, Uwajima, Ehime, 798-8510, Japan
| | - Shigehiro Miyazaki
- Department of Cardiology, Uwajima City Hospital, 1-1, Goten-machi, Uwajima, Ehime, 798-8510, Japan
| | - Hisaki Kadota
- Department of Cardiology, Uwajima City Hospital, 1-1, Goten-machi, Uwajima, Ehime, 798-8510, Japan
| | - Hideaki Shimizu
- Department of Cardiology, Uwajima City Hospital, 1-1, Goten-machi, Uwajima, Ehime, 798-8510, Japan
| | - Akiyoshi Ogimoto
- Department of Cardiology, Uwajima City Hospital, 1-1, Goten-machi, Uwajima, Ehime, 798-8510, Japan
| | - Mareomi Hamada
- Department of Cardiology, Uwajima City Hospital, 1-1, Goten-machi, Uwajima, Ehime, 798-8510, Japan
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20
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Koeda C, Yamaya S, Hozawa M, Sato M, Nasu K, Takahashi T, Terui K. Comparison of the Effects of Carperitide and Tolvaptan on Patients with Left Ventricular Dysfunction: A Two-Center Retrospective Study. Cardiol Res Pract 2017; 2017:6935342. [PMID: 28785506 PMCID: PMC5529620 DOI: 10.1155/2017/6935342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/03/2017] [Accepted: 06/11/2017] [Indexed: 11/18/2022] Open
Abstract
In patients with left ventricular (LV) dysfunction, diuretics can reduce blood pressure and lead to electrolyte abnormalities. The aim of this study was to compare the effects of tolvaptan (T group) and carperitide (C group) in these patients. Sixty-one consecutive patients admitted to the Iwate Prefectural Kuji Hospital or the Emergency Center of the Iwate Medical University between July 2011 and April 2015 were included in this study. These patients had acute heart failure (HF) and were initially treated with furosemide. Patients were excluded from the study if they received combined carperitide and tolvaptan, if they received tolvaptan or cardiotonic drugs prior to the study period, if their LV ejection fraction was ≥40%, and if they had renal dysfunction (serum creatinine > 2.0 mg/dL). There were no differences in the change in serum electrolytes in both groups, and none of the patients in the T group received supplementary dobutamine therapy. Oxygen administration was stopped successfully after a significantly shorter treatment period in the T group. These findings suggest that patients treated with tolvaptan did not require dobutamine as frequently as those treated with carperitide and indicated that tolvaptan may improve respiratory function more rapidly in patients with LV dysfunction.
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Affiliation(s)
- Chikahiko Koeda
- Division of Cardioangiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Shohei Yamaya
- Department of Cardiology, Iwate Prefectural Kuji Hospital, Iwate, Japan
| | - Maiko Hozawa
- Department of Cardiology, Iwate Prefectural Kuji Hospital, Iwate, Japan
| | - Masayuki Sato
- Department of Emergency, Iwate Medical University, Iwate, Japan
| | - Kazuhiro Nasu
- Department of Emergency, Iwate Medical University, Iwate, Japan
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21
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Safety and effectiveness of tolvaptan for fluid management after pediatric cardiovascular surgery. Gen Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s11748-017-0798-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Takasu K, Miyazaki T, Negoro K, Yatsu S, Shimizu M, Murata A, Kato T, Suda S, Hiki M, Kasai T, Miyauchi K, Daida H. Successful Treatment of Congestive Heart Failure Due to Severe Aortic Valve Stenosis With Low Dose Tolvaptan in Elderly Patients. Int Heart J 2017; 58:378-384. [PMID: 28539565 DOI: 10.1536/ihj.16-226] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Medical therapy for severe aortic valve stenosis (AS) is necessary for inoperable patients due to comorbid conditions. Tolvaptan (TLV), unlike other diuretics, resulted in modest changes in filling pressures associated with an increase in urine output, suggesting that TLV improves congestive heart failure (CHF) due to severe AS without hemodynamic instability.We retrospectively investigated 14 consecutive patients ≥ 80 years of age admitted due to decompensated CHF with severe AS at Juntendo University Hospital from April 2014 to November 2015. Seven of the 14 patients were treated with TLV. We examined the safety and efficacy of TLV treatment for severe AS.Mean age was 90.0 ± 6.3 years and mean aortic valve area was 0.57 ± 0.22 cm2. Urine volume at day 1 of TLV treatment was increased and urine osmolality significantly decreased at day 1 of TLV treatment (all P < 0.05). New York Heart Association classification and brain natriuretic peptide levels significantly improved 1 week after treatment and at discharge (all P < 0.05) whereas brain natriuretic peptide levels did not improve in the patients without TLV. Severe adverse events did not occur during TLV treatment. During the first 3 days, blood pressure and heart rate were relatively stable. TLV treatment did not affect serum creatinine, blood urea nitrogen, or the estimated glomerular filtration rate.In elderly patients with severe AS, TLV treatment improved CHF without hemodynamic instability. Further prospective studies are needed to assess the safety and efficacy of TLV in decompensated heart failure due to severe AS.
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Affiliation(s)
- Kiyoshi Takasu
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Tetsuro Miyazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Kanako Negoro
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Shoichiro Yatsu
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Megumi Shimizu
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Azusa Murata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Takao Kato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Shoko Suda
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Masaru Hiki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
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Niwa T, Waseda K, Mizuno T, Nakano Y, Mukai K, Wakabayashi H, Watanabe A, Ando H, Takashima H, Amano T. Predictability of tricuspid annular plane systolic excursion for the effectiveness of tolvaptan in patients with heart failure. J Echocardiogr 2017; 15:118-126. [PMID: 28194742 DOI: 10.1007/s12574-017-0330-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 01/08/2017] [Accepted: 01/23/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is no echocardiographic predictor of the effectiveness of tolvaptan in patients with heart failure (HF). The aim of this study was to investigate the echocardiographic predictor of responders to tolvaptan in patients with HF. METHODS This observational study consisted of 62 consecutive in-hospital patients with HF who received tolvaptan with volume overload despite standard therapies. The echocardiography data were obtained within 1 week before the administration of tolvaptan. Tolvaptan responders were defined as those having a body weight decrease from baseline >1 kg on the morning of day 8. RESULTS The mean age of the 62 patients was 75.1 ± 13.9 years, and 45 patients (72.6%) were considered to be responders. Tricuspid annular plane systolic excursion (TAPSE) was significantly higher (17.1 ± 3.8 vs. 13.0 ± 3.9 mm; p = 0.0004) and the tricuspid valve regurgitation pressure gradient (33.3 ± 14.6 vs. 44.9 ± 12.2 mmHg; p = 0.007) and estimated right atrium pressure (7.8 ± 4.2 vs. 10.3 ± 4.5 mmHg; p = 0.043) were significantly lower in the Responder group than in the Non-responder group. In a multivariate logistic regression analysis, TAPSE was found to be an independent predictor of response (odds ratio 1.28; 95% confidence interval 1.03-1.60). According to the receiver operating characteristics analysis, the area under the curve of TAPSE was the largest among the parameters measured by echocardiography. The cut-off value for TAPSE to predict responders was determined to be 17.0 mm (sensitivity = 56.8%, specificity = 94.1%). CONCLUSIONS TAPSE is a simple predictor of the effectiveness of tolvaptan in patients with HF.
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Affiliation(s)
- Toru Niwa
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Japan
| | - Katsuhisa Waseda
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Japan
| | - Tomofumi Mizuno
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Japan.
| | - Yusuke Nakano
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Japan
| | - Kentaro Mukai
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Japan
| | - Hirokazu Wakabayashi
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Japan
| | - Atsushi Watanabe
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Japan
| | - Hirohiko Ando
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Japan
| | - Hiroaki Takashima
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Japan
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Katsumata M, Hirawa N, Sumida K, Kagimoto M, Ehara Y, Okuyama Y, Fujita M, Fujiwara A, Kobayashi M, Kobayashi Y, Yamamoto Y, Saka S, Yatsu K, Fujikawa T, Toya Y, Yasuda G, Tamura K, Umemura S. Effects of tolvaptan in patients with chronic kidney disease and chronic heart failure. Clin Exp Nephrol 2017; 21:858-865. [PMID: 28190113 PMCID: PMC5648735 DOI: 10.1007/s10157-016-1379-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/30/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tolvaptan, 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). METHODS We 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. RESULTS Tolvaptan 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). CONCLUSIONS Tolvaptan 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.
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Affiliation(s)
- Mari Katsumata
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, 45-7 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Nobuhito Hirawa
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, 45-7 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Koichiro Sumida
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Minako Kagimoto
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yosuke Ehara
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yuki Okuyama
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Megumi Fujita
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, 45-7 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Akira Fujiwara
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, 45-7 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Mayumi Kobayashi
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, 45-7 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Yusuke Kobayashi
- Department of Nephrology, Yokosuka City Hospital, Yokosuka, Japan
| | - Yuichiro Yamamoto
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, 45-7 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Sanae Saka
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, 45-7 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Keisuke Yatsu
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Tetsuya Fujikawa
- Center for Health Service Sciences, Yokohama National University, Yokohama, Japan
| | - Yoshiyuki Toya
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Gen Yasuda
- Department of Nephrology and Hypertension, Yokohama City University Medical Center, 45-7 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
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25
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Affiliation(s)
- Shin-ichi Momomura
- Cardiovascular Division, Jichi Medical University Saitama Medical Center
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26
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Thajudeen B, Salahudeen AK. Role of tolvaptan in the management of hyponatremia in patients with lung and other cancers: current data and future perspectives. Cancer Manag Res 2016; 8:105-14. [PMID: 27578998 PMCID: PMC5001656 DOI: 10.2147/cmar.s90169] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Hyponatremia is the most frequently observed electrolyte abnormality in clinical practice, and its frequency is almost double in hospitalized cancer patients. As a subset of cancer, hyponatremia is quite common in lung cancer patients, and it is often coupled with the diagnosis of syndrome of inappropriate antidiuretic hormone secretion. The presence of hyponatremia is consequential in that its presence adversely affects cancer patients’ prognosis and outcomes. Limited data suggest that correcting hyponatremia in lung cancer patients can increase response to anticancer treatment, may help reduce length of hospital stay and cost, and reduce morbidity and mortality. The type of treatment for hyponatremia depends on several factors; the key factors are the duration and severity of neurological symptoms of hyponatremia and the status of extracellular volume. When hyponatremia is caused by syndrome of inappropriate antidiuretic hormone, hypertonic saline is indicated for acute symptomatic cases, whereas fluid restriction is recommended in chronic asymptomatic hyponatremia. The latter allows a slower rate of correction, thus avoiding the dreaded complication of osmotic demyelination syndrome. Fluid restriction is, however, insufficient or impractical, and often the use of pharmacological therapy such as antidiuretic hormone receptor antagonists becomes necessary. Availability of these antagonists as an effective treatment in the management of hyponatremia has been a major breakthrough, and furthermore, its clinical or investigational use in cancer-related hyponatremia may offer a potential opportunity to gain further insights into the prognostic impact of hyponatremia correction on cancer patients’ outcomes. Tolvaptan is a prototype of ADH receptor antagonists that acts at renal tubular levels to increase free water excretion without inducing major systemic electrolyte abnormalities such as hypokalemia or alkalosis. The aim of this paper is to provide a brief review while focusing on cancer hyponatremia; (1) of the epidemiology of hyponatremia and its pathophysiology and diagnostic approaches and (2) of the pharmacokinetics of tolvaptan and its clinical efficacy, safety, and compliance.
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Affiliation(s)
- Bijin Thajudeen
- Department of Nephrology, Banner University of Arizona Medical Center
| | - Abdulla K Salahudeen
- Department of Nephrology, Banner University of Arizona Medical Center; Department of Nephrology, Southern Arizona Veterans Health Care System, Tucson, AZ, USA
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Hirai K, Shimomura T, Moriwaki H, Ishii H, Shimoshikiryo T, Tsuji D, Inoue K, Kadoiri T, Itoh K. Risk factors for hypernatremia in patients with short- and long-term tolvaptan treatment. Eur J Clin Pharmacol 2016; 72:1177-1183. [PMID: 27395406 DOI: 10.1007/s00228-016-2091-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 07/01/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE The long-term efficacy of tolvaptan, a vasopressin V2 receptor antagonist, has been reported. However, the safety of long-term treatment remains to be fully elucidated. We assessed the safety profile of tolvaptan with respect to hypernatremia. METHODS This retrospective study included 371 patients treated with tolvaptan. Risk factors for hypernatremia (serum sodium concentration ≥147 mEq/L) were determined. RESULTS Hypernatremia occurred in 95 patients (25.6 %), of whom 71 (19.1 %) developed hypernatremia within 7 days of tolvaptan treatment (early onset). Stepwise logistic regression analysis demonstrated that baseline serum sodium ≥140 mEq/L, an initial tolvaptan dosage >7.5 mg, and a BUN/serum creatinine ratio ≥20 were independent risk factors for early onset of hypernatremia. Tolvaptan was prescribed for more than 7 days to 233 patients, of whom 123 were administrated tolvaptan for more than 1 month. Hypernatremia occurred in 24 of these patients (10.3 %) (late onset). Predictive factors for late onset of hypernatremia were an average daily dosage of tolvaptan >7.5 mg and age ≥75 years. CONCLUSIONS A daily dosage of 7.5 mg or less was recommended to prevent hypernatremia in short- as well as long-term tolvaptan treatment, and mainly elderly patients were at risk for hypernatremia.
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Affiliation(s)
- Keita Hirai
- Department of Clinical Pharmacology & Genetics, School of Pharmaceutical Sciences, University of Shizuoka, 52-1, Yada, Suruga-ku, Shizuoka, 422-8526, Japan.,Laboratory of Clinical Pharmacogenomics, Shizuoka General Hospital, 4-27-1, Kita-ando, Aoi-ku, Shizuoka, 420-8527, Japan
| | - Tatsuki Shimomura
- Department of Clinical Pharmacology & Genetics, School of Pharmaceutical Sciences, University of Shizuoka, 52-1, Yada, Suruga-ku, Shizuoka, 422-8526, Japan
| | - Hideaki Moriwaki
- Department of Cardiology, Shizuoka General Hospital, 4-27-1, Kita-ando, Aoi-ku, Shizuoka, 420-8527, Japan
| | - Hidetoshi Ishii
- Department of Clinical Pharmacology & Genetics, School of Pharmaceutical Sciences, University of Shizuoka, 52-1, Yada, Suruga-ku, Shizuoka, 422-8526, Japan.,Department of Pharmacy, Shizuoka General Hospital, 4-27-1, Kita-ando, Aoi-ku, Shizuoka, 420-8527, Japan
| | - Takayuki Shimoshikiryo
- Department of Clinical Pharmacology & Genetics, School of Pharmaceutical Sciences, University of Shizuoka, 52-1, Yada, Suruga-ku, Shizuoka, 422-8526, Japan
| | - Daiki Tsuji
- Department of Clinical Pharmacology & Genetics, School of Pharmaceutical Sciences, University of Shizuoka, 52-1, Yada, Suruga-ku, Shizuoka, 422-8526, Japan.,Laboratory of Clinical Pharmacogenomics, Shizuoka General Hospital, 4-27-1, Kita-ando, Aoi-ku, Shizuoka, 420-8527, Japan
| | - Kazuyuki Inoue
- Department of Clinical Pharmacology & Genetics, School of Pharmaceutical Sciences, University of Shizuoka, 52-1, Yada, Suruga-ku, Shizuoka, 422-8526, Japan.,Laboratory of Clinical Pharmacogenomics, Shizuoka General Hospital, 4-27-1, Kita-ando, Aoi-ku, Shizuoka, 420-8527, Japan
| | - Toshihiko Kadoiri
- Department of Pharmacy, Shizuoka General Hospital, 4-27-1, Kita-ando, Aoi-ku, Shizuoka, 420-8527, Japan
| | - Kunihiko Itoh
- Department of Clinical Pharmacology & Genetics, School of Pharmaceutical Sciences, University of Shizuoka, 52-1, Yada, Suruga-ku, Shizuoka, 422-8526, Japan. .,Laboratory of Clinical Pharmacogenomics, Shizuoka General Hospital, 4-27-1, Kita-ando, Aoi-ku, Shizuoka, 420-8527, Japan.
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Sato Y, Dohi K, Watanabe K, Tanimura M, Takeuchi T, Sugiura E, Sugimoto T, Kumagai N, Ogura T, Nakamori S, Fujimoto N, Yamada N, Ito M. Combination of Urinary Sodium/Creatinine Ratio and Plasma Brain Natriuretic Peptide Level Predicts Successful Tolvaptan Therapy in Patients With Heart Failure and Volume Overload. Int Heart J 2016; 57:211-9. [PMID: 26973271 DOI: 10.1536/ihj.15-330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To evaluate the short-term clinical and hemodynamic effects of tolvaptan therapy and to identify predictors of the therapeutic outcomes, we retrospectively recruited 60 consecutive hospitalized heart failure (HF) patients (70 ± 11 years) with volume overload. The subjects were divided into two groups on the basis of the changes in HF symptom scores and hemodynamic status assessed by right heart catheterization after tolvaptan therapy (median: 7 days). The majority of patients were successfully treated (group 1). However, 22% of patients (group 2) were unsuccessfully treated, in whom 1) the HF symptom score worsened or 2) there was a stationary HF symptom score ≥ 6 points, and mean PCWP > 18 mmHg and mean RAP > 10 mmHg, after tolvaptan therapy. HF symptom scores, hemodynamic parameters, and plasma brain natriuretic peptide (BNP) level improved in group 1, but all of these parameters remained unchanged in group 2. Lower urine sodium/creatinine ratio (UNa/UCr) and higher BNP level at baseline were independently associated with unsuccessful tolvaptan therapy, and UNa/UCr best predicts unsuccessful tolvaptan therapy with a cut-off value of 46.5 mEq/g·Cr (AUC 0.847, 95% CI: 0.718-0.976, sensitivity 77%, specificity 81%, P < 0.01). Double-positive results of UNa/UCr < 46.5 mEq/g·Cr and plasma BNP level > 778 pg/mL predicted unsuccessful tolvaptan therapy with high diagnostic accuracy (sensitivity 54%, specificity 100%, positive predictive value 100%, negative predictive value 89%, and accuracy 90%). In summary, short-term tolvaptan therapy ameliorated HF symptoms and provided hemodynamic improvement in the majority of patients, and UNa/UCr and BNP level strongly predicted the therapeutic outcomes.
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Affiliation(s)
- Yuichi Sato
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
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Cotter G. Hemodynamic Measures in Patients With Acute Heart Failure—Is It All That It Seems To Be? J Card Fail 2016; 22:190-2. [DOI: 10.1016/j.cardfail.2015.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 10/22/2022]
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Goto I, Dohi K, Ogihara Y, Okamoto R, Yamada N, Mitani Y, Ito M. Detrimental Impact of Vasopressin V2 Receptor Antagonism in a SU5416/Hypoxia/Normoxia-Exposed Rat Model of Pulmonary Arterial Hypertension. Circ J 2016; 80:989-97. [PMID: 26924211 DOI: 10.1253/circj.cj-15-1175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The expression of vasopressin type 2 receptor (V2R) in the lung, and the long-term effects of tolvaptan, a selective V2R antagonist, on pulmonary circulation and right ventricular (RV) remodeling in a pulmonary arterial hypertension (PAH) rat model were evaluated. METHODS AND RESULTS Six-week-old male Sprague-Dawley rats were injected subcutaneously with 20 mg/kg of SU5416 and were exposed to hypoxia for 3 weeks followed by re-exposure to normoxia for 7 weeks. These rats showed signs of RV failure and upregulation of V2R and cAMP in the lung tissue at 10 weeks after SU5416 injection. They were then treated with either 0.05% tolvaptan in diet (SUHx+Tolv) or normal diet (SUHx) during 5-10 weeks of SU5416 injection. Normal control rats (Cont) were also used for comparison. SUHx+Tolv had significantly higher pulmonary arterial pressure, more progressive pulmonary arterial remodeling, and more severe myocyte hypertrophy and interstitial myocardial fibrosis in the right ventricle compared with SUHx despite achieving successful preload reduction. CONCLUSIONS Chronic vasopressin V2R antagonism may contribute to the worsening of PAH and the development of RV remodeling.
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Affiliation(s)
- Itaru Goto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
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Higashi K, Murakami T, Ishikawa Y, Itoi T, Ohuchi H, Kodama Y, Honda T, Masutani S, Yamazawa H, Senzaki H, Ishikawa S. Efficacy and safety of tolvaptan for pediatric patients with congestive heart failure. Multicenter survey in the working group of the Japanese Society of PEdiatric Circulation and Hemodynamics (J-SPECH). Int J Cardiol 2016; 205:37-42. [DOI: 10.1016/j.ijcard.2015.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/11/2015] [Accepted: 12/12/2015] [Indexed: 11/16/2022]
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Kono T, Tayama E, Hori H, Ueda T, Yamaki Y, Tanaka H. A Safety and Efficacy Study of Tolvaptan Following Open Heart Surgery in 109 Cases. Int Heart J 2016; 57:496-502. [DOI: 10.1536/ihj.15-483] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Takanori Kono
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyushu Medical Center, National Hospital Organization of Japan
- Department of Cardiovascular Surgery, Kurume University School of Medicine
| | - Eiki Tayama
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyushu Medical Center, National Hospital Organization of Japan
| | - Hidetsugu Hori
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyushu Medical Center, National Hospital Organization of Japan
| | - Tomohiro Ueda
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyushu Medical Center, National Hospital Organization of Japan
| | - Yuta Yamaki
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyushu Medical Center, National Hospital Organization of Japan
| | - Hiroyuki Tanaka
- Department of Cardiovascular Surgery, Kurume University School of Medicine
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Early introduction of tolvaptan after cardiac surgery: a renal sparing strategy in the light of the renal resistive index measured by ultrasound. J Cardiothorac Surg 2015; 10:143. [PMID: 26525900 PMCID: PMC4631092 DOI: 10.1186/s13019-015-0372-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/28/2015] [Indexed: 12/26/2022] Open
Abstract
Background Renal failure is a serious complication after cardiac surgery, which can be caused by long-term intravenous (IV) loop diuretic use. Tolvaptan is an oral selective vasopressin-2 receptor antagonist used in patients irresponsive to loop diuretics. We investigated their renal perfusion changes using the resistive index (RI) postoperatively. Methods Serial renal RI, echocardiography, and laboratory examinations from 14 patients requiring continuous postoperative IV loop diuretics were reviewed. Eight patients received tolvaptan (Group T) and six received oral loop diuretics before the discontinuation of IV loop diuretics (Group L). The 1st data were obtained between postoperative day 0 and 2, the 2nd when patients were still under IV loop diuretic treatment, the 3rd after the initiation of tolvaptan or oral loop diuretic, and the 4th after the discontinuation of IV diuretics. Results The 2nd RI value was higher in Group T than Group L (0.77 ± 0.09 vs. 0.69 ± 0.01, p = 0.049) but significantly decreased after tolvaptan administration [0.77 ± 0.09 to 0.65 ± 0.05 (2nd to 3rd), to 0.62 ± 0.04 (to 4th), both p = 0.006], while no such changes were seen in Group L. The serum sodium and albumin levels, and echo-derived tricuspid annular plane systolic excursion increased only in Group T (134.1 ± 1.5 to 138.8 ± 3.2 mEq/L, 3.3 ± 0.3 to 3.7 ± 0.5 g/dL, 16.4 ± 3.6 to 19.7 ± 4.2 mm, all p <0.05). The duration of IV loop diuretics tended to be shorter in Group T than Group L (5.6 ± 1.6 vs. 8.7 ± 3.6 days, p = 0.051). Conclusions Administration of tolvaptan in patients undergoing cardiac surgery may improve their renal perfusion, as reflected by the renal RI measured using renal Doppler ultrasound.
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Iwasa M, Ishihara T, Hasegawa H, Takei Y. Cirrhosis-related hyponatremia and the role of tolvaptan. Hepatol Res 2015; 45:E163-5. [PMID: 26510649 DOI: 10.1111/hepr.12471] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 12/15/2014] [Accepted: 12/23/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Motoh Iwasa
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu
| | - Tomoaki Ishihara
- Department of Gastroenterology and Hepatology, Yokkaichi Digestive Disease Center, Yokkaichi, Japan
| | - Hiroshi Hasegawa
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu
| | - Yoshiyuki Takei
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu
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Toda H, Nakamura K, Nakahama M, Wada T, Watanabe A, Hashimoto K, Terasaka R, Tokioka K, Nishii N, Miyoshi T, Kohno K, Kawai Y, Miyaji K, Koide Y, Tachibana M, Yoshioka R, Ito H. Clinical characteristics of responders to treatment with tolvaptan in patients with acute decompensated heart failure: Importance of preserved kidney size. J Cardiol 2015; 67:177-83. [PMID: 26072263 DOI: 10.1016/j.jjcc.2015.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 04/17/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Recent clinical trials have demonstrated the efficacy of short-term treatment with tolvaptan, an oral vasopressin V2 receptor antagonist, in patients with heart failure. However, the response to tolvaptan varies among patients. The aim of this study was to determine factors associated with response to tolvaptan in patients with acute decompensated heart failure (ADHF). METHODS The Tolvaptan Registry, a prospective, observational, multicenter cohort study performed in Japan, aims to determine factors affecting the responsiveness of tolvaptan in patients with ADHF. We enrolled ADHF patients treated with tolvaptan and they were divided into two groups: responders and non-responders. Responders were defined as subjects who met all of the following three conditions: (1) increasing urine volume during a 24-hour period after the start of tolvaptan treatment; (2) improvement in New York Heart Association functional class; and (3) decrease in cardiothoracic ratio assessed by chest X-ray on day 3 of tolvaptan administration. RESULTS Among the 114 patients, treatment with tolvaptan improved three conditions of heart failure in more than half of all the cohorts (71 patients, 62%). As for baseline characteristics, estimated glomerular filtration rate, urine osmolality, and kidney size were significantly greater in responders than in non-responders. Multivariate logistic analysis revealed that kidney size was independently associated with responders (odds ratio: 1.083, p=0.001, 95% confidence interval 1.031-1.137). CONCLUSIONS The main clinical characteristic of responders to treatment with tolvaptan is that kidney size is preserved.
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Affiliation(s)
- Hironobu Toda
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of Cardiology, Fukuyama City Hospital, Fukuyama, Japan.
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Makoto Nakahama
- Department of Cardiology, Fukuyama City Hospital, Fukuyama, Japan
| | - Tadashi Wada
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of Cardiology, Fukuyama City Hospital, Fukuyama, Japan
| | - Atsuyuki Watanabe
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of Cardiology, Fukuyama City Hospital, Fukuyama, Japan
| | - Katsushi Hashimoto
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of Cardiology, Fukuyama City Hospital, Fukuyama, Japan
| | - Ritsuko Terasaka
- Department of Cardiology, Fukuyama City Hospital, Fukuyama, Japan
| | - Koji Tokioka
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kunihisa Kohno
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yusuke Kawai
- Department of Cardiology, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Kohei Miyaji
- Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yuji Koide
- Department of Cardiovascular Medicine, Mitoyo General Hospital, Kagawa, Japan
| | - Motomi Tachibana
- Department of Cardiology, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan
| | - Ryo Yoshioka
- Department of Cardiology, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Yamaguchi M, Nishihira K, Okubo T, Asada Y, Kitamura K. Acute Renal Injury Induced by Hypersensitivity to Tolvaptan in an Elderly Patient with Congestive Heart Failure. Intern Med 2015; 54:1243-6. [PMID: 25986264 DOI: 10.2169/internalmedicine.54.3308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Tolvaptan (TLV) is a new vasopressin type 2 receptor antagonist effective in patients with heart failure (HF). We herein describe the case of an 84-year-old woman who developed acute renal injury induced by hypersensitivity to TLV. The patient had received an implanted pacemaker and was diagnosed with exacerbation of chronic HF due to atrial fibrillation, mitral regurgitation, tricuspid regurgitation and left ventricular dyssynchrony. Treatment with tolvaptan increased the urine volume, improved the dyspnea and decreased the edema. However, the patient's renal function and hyperkalemia worsened, and the blood eosinophil count increased without signs of dehydration or hypotension. Positive findings on a drug-induced lymphocyte stimulation test for TLV were consistent with this diagnosis.
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Affiliation(s)
- Masashi Yamaguchi
- Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 2. Department of Cardiology, Miyazaki Prefectural Nichinan Hospital, Japan
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Kida K, Shibagaki Y, Tominaga N, Matsumoto N, Akashi YJ, Miyake F, Kimura K. Efficacy of Tolvaptan Added to Furosemide in Heart Failure Patients with Advanced Kidney Dysfunction: A Pharmacokinetic and Pharmacodynamic Study. Clin Pharmacokinet 2014; 54:273-84. [DOI: 10.1007/s40262-014-0194-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Matsue Y, Suzuki M, Nagahori W, Yoshida K, Onishi Y, Satoh Y, Ono Y, Nishioka T, Noda M, Sugi K, Torii S, Tejima T, Sakurada H, Yamaguchi S, Okishige K, Fujii H, Takahashi A. Clinical effectiveness of tolvaptan in patients with acute decompensated heart failure and renal failure: design and rationale of the AQUAMARINE study. Cardiovasc Drugs Ther 2014; 28:73-7. [PMID: 24048511 DOI: 10.1007/s10557-013-6491-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Over half of all admitted acute decompensated heart failure (ADHF) patients have renal failure. Although diuretics represent the mainstay of treatment strategy even in this population, there are unmet needs for safer and more effective treatment. Tolvaptan is a vasopressin-2 receptor antagonist, and we hypothesized that adding tolvaptan to standard diuretic therapy would be more effective in ADHF patients with renal function impairment. METHODS The Answering question on tolvaptan's efficacy for patients with acute decompensated heart failure and renal failure (AQUAMARINE) is a multicenter, randomized controlled clinical trial, which will enroll 220 patients from 17 hospitals in Japan. ADHF patients whose estimated glomerular filtration rate is above 15 and below 60 mL/min/1.72 m(2) will be randomly assigned within 6 h after admission to usual care with furosemide or tolvaptan add-on therapy. Primary endpoint is achieved urine output within 48 h. Secondary endpoints include dyspnea relief measured by 7-points Likert scale, incidence of worsening renal function, dose of furosemide used within 48 h, and changes of brain natriuretic peptide. CONCLUSION This study is the first multicenter study in Japan to evaluate clinical effectiveness of tolvaptan add-on therapy in ADHF patients with renal failure. The results of this study address the treatment strategy of this high-risk population (UMIN Clinical Trial Registry Number: UMIN000007109).
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Affiliation(s)
- Yuya Matsue
- Department of Cardiology, Kameda Medical Center, 929 Higashi-chou, Kamogawa-City, Chiba, 296-8602, Japan,
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Hiramatsu T, Hobo A, Hayasaki T, Kabu K, Furuta S. A Pilot Study Examining the Effects of Tolvaptan on Residual Renal Function in Peritoneal Dialysis for Diabetics. Perit Dial Int 2014; 35:552-8. [PMID: 25082843 DOI: 10.3747/pdi.2013.00290] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 03/18/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND For patients with end-stage renal disease (ESRD), peritoneal dialysis (PD) serves as a possible renal replacement therapy. However, most PD patients, particularly those with ESRD and diabetes mellitus, reportedly discontinue PD early, resulting in shorter survival periods and poorer prognosis because of overhydration. Recently, the vasopressin-2 receptor antagonist tolvaptan was approved for volume control in patients with heart failure. The present study aimed to identify the effects of tolvaptan in diabetic PD patients. METHODS In this pilot study, the tolvaptan group (n = 12) were treated with 15 mg/day of tolvaptan 2 weeks after PD initiation and were prospectively analyzed for 1 year, and patients in the control group (n = 12) did not receive tolvaptan and were retrospectively analyzed for 1 year. In addition to the biochemical tests, echocardiograms, serum atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels, peritoneal Kt/V, and creatinine clearance (CCr) were examined at baseline and at 6 and 12 months after PD initiation. RESULTS In the control group, the urine volume, renal Kt/V, and renal CCr levels consistently decreased; however, these parameters were stably maintained during the study period in the tolvaptan group. Atrial natriuretic peptide, CRP levels and the left ventricular mass index of the tolvaptan-treated group were significantly lower than those in the control group, whereas total protein and albumin levels were significantly higher at 6 and 12 months in the tolvaptan group. There were no obvious adverse effects. CONCLUSIONS These data suggest that tolvaptan may preserve residual renal function and improve volume control in PD patients with diabetes mellitus.
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Affiliation(s)
- Takeyuki Hiramatsu
- Department of Nephrology, Aichi Welfare Cooperative Agricultural Federation, Konan-Kosei Hospital, Konan-city, Aichi, Japan
| | - Akinori Hobo
- Department of Nephrology, Aichi Welfare Cooperative Agricultural Federation, Konan-Kosei Hospital, Konan-city, Aichi, Japan
| | - Takahiro Hayasaki
- Department of Nephrology, Aichi Welfare Cooperative Agricultural Federation, Konan-Kosei Hospital, Konan-city, Aichi, Japan
| | | | - Shinji Furuta
- Department of Nephrology, Aichi Welfare Cooperative Agricultural Federation, Konan-Kosei Hospital, Konan-city, Aichi, Japan
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Abstract
Fluid management is of paramount importance in the treatment strategy of heart failure (HF), but the therapeutic efficacy of loop diuretic-based treatment for HF patients is limited by insufficient response and adverse effects. Clinical data establishing the efficacy and safety of tolvaptan, a selective oral vasopressin V2 receptor antagonist that induces aquaresis, have recently been accumulated over 3 years of daily clinical experience in Japan. Intravenous infusion of carperitide, a synthetic α-human atrial natriuretic peptide, has also been widely used as acute-phase therapy for acute decompensated HF in Japan. Combination therapy using loop diuretics, tolvaptan, and carperitide with differing and complementary mechanisms of action may maximize therapeutic activity, to minimize the dosage of loop diuretics and thereby reduce the adverse effects not only for volume removal but also for the stability of cardiorenal hemodynamics.
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Affiliation(s)
- Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
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41
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Patra S, Kumar B, Harlalka KK, Jain A, Bhanuprakash HM, Sadananda KS, Basappa H, Santhosh K, Rajith KS, Bharathi KS, Manjunath CN. Short term efficacy and safety of low dose tolvaptan in patients with acute decompensated heart failure with hyponatremia: a prospective observational pilot study from a single center in South India. Heart Views 2014; 15:1-5. [PMID: 24949180 PMCID: PMC4062982 DOI: 10.4103/1995-705x.132136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: In acute decompensated heart failure (ADHF), diuretic use, the mainstay therapy for congestion, is associated with electrolyte abnormalities and worsening renal function. Vasopressin mediates fluid retention in heart failure. In contrast to diuretics, the vasopressin antagonist tolvaptan may increase net volume loss in heart failure without adversely affecting electrolytes and renal function. Hyponatremia (serum sodium concentration, <135 mEq/L) is a predictor of death among patients with heart failure. Objective: We prospectively observed the short term efficacy and safety of low dose (15 mg) tolvaptan in admitted patients with hyponatremia and ADHF in Indian population. Methodology: A total of 40 patients with ADHF along with hyponatremia (<125 mEq/L) on standard therapy were treated with 15 mg of tolvaptan at a single oral dose for 7 days. Results: Serum sodium concentrations increased significantly after treatment with tolvaptan from baseline (P < 0.02). There was a significant improvement in symptoms and New York Heart Association (NYHA) class after starting tolvaptan (P ≤ 0.05). Total diuretic dose and mean body weight was reduced non-significantly at 7th day from the baseline. Side-effects associated with tolvaptan included increased thirst, dry mouth and increased urination. Few patients had worsening renal function. However, several patients developed hypernatremia. Conclusion: In this small observational study, tolvaptan initiation in patients with ADHF with hyponatremia in addition to standard therapy may hold promise in improvement in NYHA class and serum sodium. At the same time, we observed that serious adverse events such as renal function deterioration and hypernatremia developed after tolvaptan treatment, which needs to be addressed in future by randomized study with larger sample size.
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Affiliation(s)
- Soumya Patra
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore Branch, K.R. Hospital Campus, Mysore, Karnataka, India
| | - Basant Kumar
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore Branch, K.R. Hospital Campus, Mysore, Karnataka, India
| | - Kaushal K Harlalka
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore Branch, K.R. Hospital Campus, Mysore, Karnataka, India
| | - Apoorva Jain
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore Branch, K.R. Hospital Campus, Mysore, Karnataka, India
| | - H M Bhanuprakash
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore Branch, K.R. Hospital Campus, Mysore, Karnataka, India
| | - K S Sadananda
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore Branch, K.R. Hospital Campus, Mysore, Karnataka, India
| | - Harsha Basappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore Branch, K.R. Hospital Campus, Mysore, Karnataka, India
| | - K Santhosh
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore Branch, K.R. Hospital Campus, Mysore, Karnataka, India
| | - K S Rajith
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore Branch, K.R. Hospital Campus, Mysore, Karnataka, India
| | - K S Bharathi
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore Branch, K.R. Hospital Campus, Mysore, Karnataka, India
| | - C N Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore Branch, K.R. Hospital Campus, Mysore, Karnataka, India
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Imamura T, Kinugawa K, Minatsuki S, Muraoka H, Kato N, Inaba T, Maki H, Hatano M, Yao A, Komuro I. Tolvaptan can improve clinical course in responders. Int Heart J 2014; 54:377-81. [PMID: 24309447 DOI: 10.1536/ihj.54.377] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We previously defined "responders" as patients with increases in urine volume (UV) on day 1 after the administration of tolvaptan (TLV), and demonstrated that responders to TLV could be predicted with considerable accuracy by urine osmolality (U-OSM) levels. Responders and non-responders to TLV should be associated with different clinical courses after a certain time following TLV administration. Therefore, the aim of the present study was to validate our definition of responders by clinical parameters 1 week after administration of TLV. Data (n = 85) were obtained from in hospital patients with decompensated heart failure (HF) who had received TLV at 3.75-15 mg daily, and clinical data at 1 week after the administration of TLV were compared with those of baseline. Sixty patients (70.6%) were "responders", in whom UV on day 1 increased after the administration of TLV compared with day 0. "Non-responders" were older, and had higher serum creatinine concentration and lower baseline U-OSM than "responders". Serum creatinine concentration increased significantly in "non-responders", but was unchanged in "responders". Body weight, plasma B-type natriuretic peptide concentration, and HF symptom score decreased significantly in "responders", but remained unchanged in "non-responders". Increases in UV after the first administration of TLV were closely correlated with improvement of congestive HF after 1 week of TLV treatment, which verified our definition of "responders" to TLV.
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Affiliation(s)
- Teruhiko Imamura
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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43
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Affiliation(s)
- Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
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44
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Ogihara Y, Yamada N, Dohi K, Matsuda A, Tsuji A, Ota S, Ishikura K, Nakamura M, Ito M. Utility of right ventricular Tei-index for assessing disease severity and determining response to treatment in patients with pulmonary arterial hypertension. J Cardiol 2014; 63:149-53. [DOI: 10.1016/j.jjcc.2013.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 06/06/2013] [Accepted: 07/02/2013] [Indexed: 10/26/2022]
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45
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Imamura T, Kinugawa K, Ohtani T, Sakata Y, Higo T, Kinugawa S, Tsutsui H, Sunagawa K, Komuro I. Assessment of Quality of Life During Long-Term Treatment of Tolvaptan in Refractory Heart Failure. Int Heart J 2014; 55:264-7. [DOI: 10.1536/ihj.13-326] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Teruhiko Imamura
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Koichiro Kinugawa
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Osaka
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Osaka
| | - Taiki Higo
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Hokkaido University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medicine, Hokkaido University
| | - Kenji Sunagawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
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46
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Imamura T, Kinugawa K, Minatsuki S, Muraoka H, Kato N, Inaba T, Maki H, Hatano M, Yao A, Komuro I. Urine Sodium Excretion After Tolvaptan Administration Is Dependent Upon Baseline Serum Sodium Levels. Int Heart J 2014; 55:131-7. [DOI: 10.1536/ihj.13-221] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Teruhiko Imamura
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Koichiro Kinugawa
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
| | - Shun Minatsuki
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Hironori Muraoka
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Naoko Kato
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
| | - Toshiro Inaba
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Hisataka Maki
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Atsushi Yao
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
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47
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Tolvaptan increases urine and ultrafiltration volume for patients with oliguria undergoing peritoneal dialysis. Clin Exp Nephrol 2013; 18:655-61. [PMID: 24113781 DOI: 10.1007/s10157-013-0883-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 09/25/2013] [Indexed: 01/26/2023]
Abstract
BACKGROUND Hypoalbuminemia caused by peritoneal dialysate protein loss, frequently occurs in patients on peritoneal dialysis (PD) and is associated with an increased risk of death. We investigate whether PD dialysis exchange volume (PD volume) could be reduced with tolvaptan (TVP) through increased urine volume (UV). METHODS The study included 11 stable patients with oliguria undergoing PD. The following parameters were examined-diuretic response and the effect of TVP on peritoneal ultrafiltration (UF), body weight, serum albumin, sodium, arm muscle area (AMA), PD volume, dialysis efficiency calculator (K t/V), and urine and serum osmolarity (OSM). RESULTS The average UV increased from 428 ± 178 to 906 ± 285 mL (p = 0.018 by paired t test). Average weekly PD volume decreased from 28,836 ± 5,699 to 23,872 ± 3,569 mL (p = 0.04 by paired t test). Average UF increased from 283 ± 147 to 575 ± 135 mL (p = 0.019 by paired t test). On the other hand, there was no significant difference in the average dialysate K t/V before and after TVP treatment. Serum sodium, AMA, and serum albumin levels were not statistically different before and after TVP treatment. The urine and serum OSM ratio of effective cases before TVP treatment was higher than that of ineffective cases (p = 0.024 by unpaired t test). CONCLUSION Our results indicate that TVP is useful for patients on continuous ambulatory PD who have oliguria and high urine osmolarity. Furthermore, we can reduce PD volume to maintain their nutritional status.
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Filippatos TD, Elisaf MS. Hyponatremia in patients with heart failure. World J Cardiol 2013; 5:317-328. [PMID: 24109495 PMCID: PMC3783984 DOI: 10.4330/wjc.v5.i9.317] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 07/30/2013] [Accepted: 08/17/2013] [Indexed: 02/06/2023] Open
Abstract
The present review analyses the mechanisms relating heart failure and hyponatremia, describes the association of hyponatremia with the progress of disease and morbidity/mortality in heart failure patients and presents treatment options focusing on the role of arginine vasopressin (AVP)-receptor antagonists. Hyponatremia is the most common electrolyte disorder in the clinical setting and in hospitalized patients. Patients with hyponatremia may have neurologic symptoms since low sodium concentration produces brain edema, but the rapid correction of hyponatremia is also associated with major neurologic complications. Patients with heart failure often develop hyponatremia owing to the activation of many neurohormonal systems leading to decrease of sodium levels. A large number of clinical studies have associated hyponatremia with increased morbidity and mortality in patients hospitalized for heart failure or outpatients with chronic heart failure. Treatment options for hyponatremia in heart failure, such as water restriction or the use of hypertonic saline with loop diuretics, have limited efficacy. AVP-receptor antagonists increase sodium levels effectively and their use seems promising in patients with hyponatremia. However, the effects of AVP-receptor antagonists on hard outcomes in patients with heart failure and hyponatremia have not been thoroughly examined.
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Imamura T, Kinugawa K, Kato N, Minatsuki S, Muraoka H, Inaba T, Maki H, Shiga T, Hatano M, Hosoya Y, Takahashi M, Yao A, Kyo S, Ono M, Komuro I. A Case With Recovery of Response to Tolvaptan Associated With Remission of Acute Kidney Injury and Increased Urine Osmolality. Int Heart J 2013; 54:115-8. [DOI: 10.1536/ihj.54.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Teruhiko Imamura
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Koichiro Kinugawa
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Naoko Kato
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Shun Minatsuki
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hironori Muraoka
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Toshiro Inaba
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hisataka Maki
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Taro Shiga
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Yumiko Hosoya
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Masao Takahashi
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Atsushi Yao
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Shunei Kyo
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Minoru Ono
- Department of Cardiothoracic Surgery, Graduate School of Medicine, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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