Prognostic impact of the acute reactiveness to intravenous administration of tolvaptan sodium phosphate in patients with acute decompensated heart failure

Abstract Background Intravenous tolvaptan sodium phosphate (IV-Tolvaptan) is a novel aquaretic agent for acute decompensated heart failure (ADHF). This study evaluated its short-term effects and prognostic implications in clinical practice. Methods In this retrospective cohort of 169 consecutive ADHF patients receiving IV-Tolvaptan for the first time (mean age 76.0 ± 12.7 years; 50.9 % female), we measured hourly urine output over 6 hours and assessed clinical and biochemical parameters at baseline and 24 hours post-dose. The primary endpoint was a composite of all-cause mortality and heart failure rehospitalization. Results At 24 hours, IV-Tolvaptan significantly reduced body weight (mean difference: –1.1 ± 2.3 kg, p0.001), NT-proBNP (median change: –1,704 pg/mL; p 0.001) and urinary osmolality (mean change: –71.4 ± 169.4 mOsm/kg; p =0.015), while raising serum sodium (mean change: 1.7 ± 2.9 mEq/L; p 0.001). Six-hour urine output correlated with baseline eGFR (r = 0.34; p 0.001), urinary osmolality (r = 0.28; p = 0.003) and the change of serum sodium (r = 0.21; p = 0.005). In multivariable logistic regression, renal impairment (eGFR60 ml/min/1.73m2) (odds ratio (OR) 0.2; 95 % confidence interval (CI) 0.1–0.4; p0.001) and higher furosemide doses (20mg) (OR 0.3; 95 % CI 0.2–0.6; p = 0.01) predicted reduced responsiveness, whereas first hospitalization (OR 2.2; 95 % CI 1.1–4.5; p = 0.04) and high urinary osmolality (OR 2.3; 95 % CI 1.0–5.4; p = 0.05) predicted favorable response. Kaplan–Meier analysis demonstrated a lower incidence of the primary endpoint in patients achieving ≥ 1,000 mL urine output (log-rank p = 0.032). Conclusions IV-Tolvaptan enhances decongestion and short-term outcomes in ADHF without worsening renal function. Early diuretic responsiveness is a robust prognostic marker.