Impact of renal function on mid-term outcomes in heart failure patients treated with tolvaptan
Background: Although tolvaptan, an electrolyte-free water diuretic for congestive heart failure (HF), is reported to have no effect on long-term mortality or HF-related morbidity, there may exist some subgroups of patients who may receive beneficial effect of tolvaptan. The purpose of this study was...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2019-01-01
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| Series: | Therapeutic Advances in Cardiovascular Disease |
| Online Access: | https://doi.org/10.1177/1753944718819064 |
| _version_ | 1818130707909705728 |
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| author | Kensuke Fujioka Sumio Mizuno Taro Ichise Takao Matsui Hiroaki Hirase Masato Yamaguchi Takahiko Aoyama Masakazu Yamagishi Noboru Fujino Masa-aki Kawashiri Kenshi Hayashi |
| author_facet | Kensuke Fujioka Sumio Mizuno Taro Ichise Takao Matsui Hiroaki Hirase Masato Yamaguchi Takahiko Aoyama Masakazu Yamagishi Noboru Fujino Masa-aki Kawashiri Kenshi Hayashi |
| author_sort | Kensuke Fujioka |
| collection | DOAJ |
| description | Background: Although tolvaptan, an electrolyte-free water diuretic for congestive heart failure (HF), is reported to have no effect on long-term mortality or HF-related morbidity, there may exist some subgroups of patients who may receive beneficial effect of tolvaptan. The purpose of this study was to identify clinical factors associated with mid-term effect of tolvaptan on clinical outcomes of patients who discharged after acute HF. Methods: We retrospectively analyzed 140 patients (88 male; mean age, 77.1 ± 11.0 years) with acute HF who received tolvaptan (initial dose 8.6 ± 3.6 mg/day) during their hospitalization. They were divided into two groups according to how the tolvaptan was used at discharge; 77 in the tolvaptan-continued group and 63 in the discontinued group. Results: The Cox proportional hazards model revealed that eGFR was the only independent predictor for the occurrence of mid-term cardiac events (composite of re-hospitalization due to HF and all-cause death; aHR = 0.9870, p = 0.02597). The Kaplan–Meier survival curves of the two groups demonstrated no difference in cumulative event-free rates. In the subgroup with preserved renal function at admission (eGFR ⩾ 30 ml/min/1.73 m 2 ), the continuous use of tolvaptan increased composite events (aHR = 2.130, p = 0.02549). Conclusions: The continuous use of tolvaptan after discharge did not affect mid-term cardiac events of HF overall but may be associated with increased cardiac events in the subgroup with preserved renal function. These findings suggest that the tolvaptan administration might need to be limited to treatment of in-hospital acute HF. |
| first_indexed | 2024-12-11T08:09:19Z |
| format | Article |
| id | doaj.art-0134b8f924314b3685ed9a97fb0f64a8 |
| institution | Directory Open Access Journal |
| issn | 1753-9455 |
| language | English |
| last_indexed | 2024-12-11T08:09:19Z |
| publishDate | 2019-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Cardiovascular Disease |
| spelling | doaj.art-0134b8f924314b3685ed9a97fb0f64a82022-12-22T01:14:55ZengSAGE PublishingTherapeutic Advances in Cardiovascular Disease1753-94552019-01-011310.1177/1753944718819064Impact of renal function on mid-term outcomes in heart failure patients treated with tolvaptanKensuke FujiokaSumio MizunoTaro IchiseTakao MatsuiHiroaki HiraseMasato YamaguchiTakahiko AoyamaMasakazu YamagishiNoboru FujinoMasa-aki KawashiriKenshi HayashiBackground: Although tolvaptan, an electrolyte-free water diuretic for congestive heart failure (HF), is reported to have no effect on long-term mortality or HF-related morbidity, there may exist some subgroups of patients who may receive beneficial effect of tolvaptan. The purpose of this study was to identify clinical factors associated with mid-term effect of tolvaptan on clinical outcomes of patients who discharged after acute HF. Methods: We retrospectively analyzed 140 patients (88 male; mean age, 77.1 ± 11.0 years) with acute HF who received tolvaptan (initial dose 8.6 ± 3.6 mg/day) during their hospitalization. They were divided into two groups according to how the tolvaptan was used at discharge; 77 in the tolvaptan-continued group and 63 in the discontinued group. Results: The Cox proportional hazards model revealed that eGFR was the only independent predictor for the occurrence of mid-term cardiac events (composite of re-hospitalization due to HF and all-cause death; aHR = 0.9870, p = 0.02597). The Kaplan–Meier survival curves of the two groups demonstrated no difference in cumulative event-free rates. In the subgroup with preserved renal function at admission (eGFR ⩾ 30 ml/min/1.73 m 2 ), the continuous use of tolvaptan increased composite events (aHR = 2.130, p = 0.02549). Conclusions: The continuous use of tolvaptan after discharge did not affect mid-term cardiac events of HF overall but may be associated with increased cardiac events in the subgroup with preserved renal function. These findings suggest that the tolvaptan administration might need to be limited to treatment of in-hospital acute HF.https://doi.org/10.1177/1753944718819064 |
| spellingShingle | Kensuke Fujioka Sumio Mizuno Taro Ichise Takao Matsui Hiroaki Hirase Masato Yamaguchi Takahiko Aoyama Masakazu Yamagishi Noboru Fujino Masa-aki Kawashiri Kenshi Hayashi Impact of renal function on mid-term outcomes in heart failure patients treated with tolvaptan Therapeutic Advances in Cardiovascular Disease |
| title | Impact of renal function on mid-term outcomes in heart failure patients treated with tolvaptan |
| title_full | Impact of renal function on mid-term outcomes in heart failure patients treated with tolvaptan |
| title_fullStr | Impact of renal function on mid-term outcomes in heart failure patients treated with tolvaptan |
| title_full_unstemmed | Impact of renal function on mid-term outcomes in heart failure patients treated with tolvaptan |
| title_short | Impact of renal function on mid-term outcomes in heart failure patients treated with tolvaptan |
| title_sort | impact of renal function on mid term outcomes in heart failure patients treated with tolvaptan |
| url | https://doi.org/10.1177/1753944718819064 |
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