What question did this study set out to answer?

To identify predictors influencing the effectiveness of tolvaptan in managing acute decompensated heart failure and its impact on renal outcomes.

March 28, 2026Open Access

Wcn26-6457 Predictors of Tolvaptan Effectiveness in Acute Decompensated Heart Failure: Impact on Renal Outcomes, Oxygen Requirement, and Hospital Stay

Key Result

Severe cardiac-associated AKI confers markedly worse 2-year outcomes than non-cardiac AKI, with lack of early renal recovery strongly predicting poor prognosis (aHR 5.56).

Key Points

To identify predictors influencing the effectiveness of tolvaptan in managing acute decompensated heart failure and its impact on renal outcomes.
Analyzed associations between tolvanptan's effectiveness and various predictors in patients with acute decompensated heart failure.
Evaluated renal outcomes, oxygen requirements, and hospital stay length.
Examined the impact of early renal recovery and cardiac-associated AKI on prognosis.
Severe cardiac-associated AKI resulted in significantly worse 2-year kidney and survival outcomes compared to non-cardiac AKI.
Early renal recovery was identified as the strongest predictor of better prognosis.
No association was found between initial renal replacement therapy type and post-discharge medication use with risk outcomes.

Structured PICO

Does adjunctive tolvaptan therapy improve in-hospital outcomes in adults admitted for acute decompensated heart failure?

Population

Adults aged 18 years and above admitted for acute decompensated heart failure (ADHF), excluding those with end-stage kidney disease (ESKD) or chronic kidney disease (CKD) stage 5, and those requiring invasive mechanical ventilation within six hours of presentation

Intervention

Adjunctive therapy with 7.5 mg tolvaptan at six hours of ADHF presentation

Comparator

Conventional diuretic therapy alone

Outcome

In-hospital outcomes of adjunctive tolvaptan therapy at six hours of ADHF presentation and predictors of tolvaptan effectiveness

Early adjunctive tolvaptan therapy in acute decompensated heart failure improves diuresis and symptom relief while reducing worsening renal function and hospital stay.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

discharge (aHR 5.56; all P<0.05).Initial RRT type and post-discharge use of ACEI/ARBs or beta-blockers were not associated with risk. Conclusion:Severe cardiac-associated AKI in resource-limited settings confers markedly worse 2-year kidney and survival outcomes than non-cardiac AKI.Lack of early renal recovery is the strongest predictor of poor prognosis, highlighting the need for targeted monitoring and cardiorenal protection strategies in high-risk patients.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.

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