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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...

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Autores principales: Fujioka, Kensuke, Mizuno, Sumio, Ichise, Taro, Matsui, Takao, Hirase, Hiroaki, Yamaguchi, Masato, Aoyama, Takahiko, Yamagishi, Masakazu, Fujino, Noboru, Kawashiri, Masa-aki, Hayashi, Kenshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6348497/
https://www.ncbi.nlm.nih.gov/pubmed/30803403
http://dx.doi.org/10.1177/1753944718819064
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author Fujioka, Kensuke
Mizuno, Sumio
Ichise, Taro
Matsui, Takao
Hirase, Hiroaki
Yamaguchi, Masato
Aoyama, Takahiko
Yamagishi, Masakazu
Fujino, Noboru
Kawashiri, Masa-aki
Hayashi, Kenshi
author_facet Fujioka, Kensuke
Mizuno, Sumio
Ichise, Taro
Matsui, Takao
Hirase, Hiroaki
Yamaguchi, Masato
Aoyama, Takahiko
Yamagishi, Masakazu
Fujino, Noboru
Kawashiri, Masa-aki
Hayashi, Kenshi
author_sort Fujioka, Kensuke
collection PubMed
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.
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spelling pubmed-63484972019-02-04 Impact of renal function on mid-term outcomes in heart failure patients treated with tolvaptan Fujioka, Kensuke Mizuno, Sumio Ichise, Taro Matsui, Takao Hirase, Hiroaki Yamaguchi, Masato Aoyama, Takahiko Yamagishi, Masakazu Fujino, Noboru Kawashiri, Masa-aki Hayashi, Kenshi Ther Adv Cardiovasc Dis Original Research 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. SAGE Publications 2019-01-15 /pmc/articles/PMC6348497/ /pubmed/30803403 http://dx.doi.org/10.1177/1753944718819064 Text en © The Author(s), 2019 http://www.creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research
Fujioka, Kensuke
Mizuno, Sumio
Ichise, Taro
Matsui, Takao
Hirase, Hiroaki
Yamaguchi, Masato
Aoyama, Takahiko
Yamagishi, Masakazu
Fujino, Noboru
Kawashiri, Masa-aki
Hayashi, Kenshi
Impact of renal function on mid-term outcomes in heart failure patients treated with tolvaptan
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
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6348497/
https://www.ncbi.nlm.nih.gov/pubmed/30803403
http://dx.doi.org/10.1177/1753944718819064
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