Renoprotective Benefit of Tolvaptan in Acute Decompensated Heart Failure Patients With Loop Diuretic-Resistant Status

BACKGROUND: While reduction of accumulated body fluid using loop diuretics is a commonly used therapeutic option for acute heart failure (AHF), some patients, especially those with chronic kidney disease (CKD), show significantly poor treatment response to loop diuretics. Tolvaptan (TLV) has shown effectiveness against AHF in several studies. We have been using TLV for AHF treatment, and it displayed favorable outcome even in patients with CKD. This study aimed to assess the therapeutic effectiveness of TLV in AHF patients. METHODS: Ninety-nine AHF patients who were hospitalized were assessed retrospectively. Patients were divided into two groups: TLV treatment (TLV group, n = 39) and conventional treatment (non-TLV group, n = 60). We retrospectively examined the efficacy of TLV combination therapy for renal insufficiency complications and loop diuretic-resistant AHF patients, and the detail analysis was performed for heart failure with preserved ejection fraction (HFpEF) or reduced ejection fraction (HFrEF) in patients. RESULTS: Changes in serum electrolyte levels before and after the treatment were similar in both groups. Although the patients in the TLV group at baseline displayed significantly lower estimated glomerular filtration rate (eGFR) indicating renal insufficiency probably due to higher dose of loop diuretics, the incidence of worsening renal function (WRF) was significantly lower than those in non-TLV group in HFpEF (TLV: 2.5% vs. non-TLV: 15.4%, P = 0.01). We performed logistic regression analysis and found that TLV was an independent contributing factor for reducing WRF (odds ratio: 0.14, 95% CI: 0.02 - 0.98, P = 0.04). CONCLUSIONS: Our results suggest that TLV application in acute stage may be renoprotective for AHF patients with CKD, especially in HFpEF.