Prognostic impact of early treatment with tolvaptan in patients with acute heart failure and renal dysfunction. (15th October 2016)

• Record Type: Journal Article
• Authors: Matsue, Yuya; Suzuki, Makoto; Torii, Sho; Yamaguchi, Satoshi; Fukamizu, Seiji; Ono, Yuichi; Fujii, Hiroyuki; Kitai, Takeshi; Nishioka, Toshihiko; Sugi, Kaoru; Onishi, Yuko; Noda, Makoto; Kagiyama, Nobuyuki; Satoh, Yasuhiro; Yoshida, Kazuki; Goldsmith, Steven R.
• Is Part Of: International journal of cardiology. Volume 221(2016)
• Page Start: 188
• Page End: 193
• Publication Date: 2016-10-15
• Subjects: Acute heart failure -- Renal dysfunction -- Prognosis -- Neurohormonal activity; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.07.063
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Renal dysfunction is a common comorbidity in acute heart failure (AHF) patients. The prognostic significance of early treatment with tolvaptan in AHF patients complicated with renal dysfunction has not been elucidated. Methods: Post hoc analysis was performed on a randomized clinical study for prespecified prognostic endpoints and prespecified subgroups. 217 AHF patients with renal dysfunction (eGFR 15 to 60 mL/min/1.73 m 2 ) were randomized within 6 h from hospitalization to either tolvaptan treatment for 2 days or conventional treatment. The primary outcome was the combined endpoint of all-cause death and HF readmission. Results: During follow-up (636 days, median) 99 patients experienced combined endpoint and 53 patients died. There was no significant difference in event-free survival rate for either the combined events (Log-rank: P = 0.197) or all-cause death (Log-rank: P = 0.894) between tolvaptan and conventional groups. In prespecified subgroup analysis, in patients whose BUN/creatinine ratio was above the median (> 20), tolvaptan significantly reduced the risk of combined events (HR: 0.52, 95% CI: 0.30–0.91, P = 0.021) with a significant interaction (P value for interaction = 0.045). Likewise, in patients whose eGFR was 30 mL/min/1.73 m 2 or above, tolvaptan reduced the risk of combined events (HR: 0.54, 95% CI: 0.32–0.90, P = 0.017) with a significant interaction (P value for interaction = 0.015). Conclusion: Short-term use of tolvaptan in acute-phase in AHF with renal dysfunction showed a neutral effect on prognosis. Patients with relatively preserved renal function and relatively high BUN/creatinine ratios are potentially favorable subgroups for treatment with tolvaptan.