Why the study?
Existing evidence from systematic reviews and meta-analyses on the effectiveness of tolvaptan for water retention in heart failure needed to be collected, appraised, and synthesized.
Does tolvaptan improve serum sodium concentration and urine output in patients with heart failure and water retention?
Does tolvaptan improve serum sodium concentration and urine output in patients with heart failure and water retention?
Tolvaptan effectively improves serum sodium, urine output, and weight loss in heart failure patients with water retention, though it does not reduce all-cause mortality and the current evidence quality is low.
May support recommending tolvaptan for HF water retention; leaves open need for additional rigorous trials.
OBJECTIVE: The purpose of this systematic review is to collect, appraise, and synthesize existing evidence from systematic reviews and meta-analyses (SRs/MAs) on the effectiveness of tolvaptan for water retention in heart failure. METHODS: A comprehensive literature search was performed on PubMed, EMBASE, web of science, Cochrane reviews for SRs/Mas published between the databases' establishment to November 17, 2021. All the records were managed with Endnote 20. Standardized forms were used to extract data. Revman 5.3 was used to make forest plots to show the characteristics of outcomes. The methodological and evidence quality were respectively evaluated by AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews 2) and GRADE (Grading of Recommendation of Assessment, Development, and Evaluation) system. RESULTS: A total of 9 SRs/Mas between 2015 to 2020 met inclusion criteria. Serum sodium concentration and urine output were considered as primary outcomes and body weight change and all-cause mortality as second outcomes. Through conducting forest plots, it appeared that tolvaptan brought more positive effect than conventional therapies. It was pessimistic when it comes to the quality of the 9 studies. all the 9 articles were rated as low-quality because AMSTAR 2 evaluation showed that they each had at least one critical item (items 2, 4, 7, 9, 11, 13 and 15) defect. Besides, every article had a few non-critical item defects too. The result of GRADE assessment was not optimistic, so the overall quality of the evidences was low as well. CONCLUSION: Tolvaptan can be recommended for water retention in HF patients, but more evidence is needed.
No takes yet. Share an insight, caveat, or question.
Pan et al. (2023) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: