Key result
Tolvaptan co-administered with conventional diuretics significantly increased mean postoperative urine output (MD 0.39) compared to conventional diuretics alone in cardiac surgery patients.
Why the study?
Evidence from randomized controlled trials comparing tolvaptan with conventional diuretics for postoperative fluid management in cardiac surgery patients had not been systematically analyzed.
Does tolvaptan co-administered with conventional diuretics improve postoperative fluid management in adult patients undergoing cardiac surgery?
Meta-Analysis (n=426)
Does tolvaptan co-administered with conventional diuretics improve postoperative fluid management in adult patients undergoing cardiac surgery?
In patients undergoing cardiac surgery, adding tolvaptan to conventional diuretics significantly increases urine output and accelerates the return to pre-operative body weight without increasing arrhythmias.
May improve fluid management after cardiac surgery; extends meta-analytic support for tolvaptan as diuretic adjunct.
The purpose of this study was to systematically search the literature and analyze evidence from randomized controlled trials (RCTs) comparing tolvaptan with conventional diuretics for postoperative fluid management in cardiac surgery patients. An electronic search of PubMed, Scopus, BioMed Central, CENTRAL (Cochrane Central Register of Controlled Trials) and Google scholar databases was carried out up to 1st December 2019. Four RCTs were included. Tolvaptan was co‑administered with conventional diuretics in all the studies. The mean postoperative urine output was significantly greater in patients receiving tolvaptan as compared to controls (MD=0.39; 95% CI: 0.17 to 0.61; P=0.006, I2=48%). Body weight of patients on tolvaptan returned to pre‑operative levels significantly earlier (MD=‑1.57; 95% CI: ‑2.48 to ‑0.66; P=0.007, I2=50%). There was statistical significant difference in the highest postoperative serum sodium levels (MD=2.34; 95% CI: ‑1.65 to 3.03; p<0.00001, I2=0%), lowest serum sodium levels (MD=2.05; 95% CI: 1.41 to 2.68; p<0.00001, I2=0%) and mean serum sodium levels (MD=1.69; 95% CI: 0.98 to 2.40; p<0.00001, I2=0%) between the tolvaptan and control groups. Lowest serum potassium was significantly higher with tolvaptan as compared to the control group (MD=0.10; 95% CI: 0.01 to 0.18; P=0.03, I2=19%). There was no significant difference in the length of ICU stay or incidence of arrhythmias between the two groups. The quality of the included studies was not high. Within the limitations of our study, our results indicate that co‑administration of tolvaptan with low dose of conventional diuretics significantly increases urine output while maintaining electrolyte balance in postoperative cardiac surgery patients. Faster return of body weight to pre‑operative levels is evident with tolvaptan. Further high‑quality RCTs are required to confirm this evidence.
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Chen et al. (2020) conducted a meta-analysis in postoperative fluid management in cardiac surgery (n=426). Tolvaptan vs. conventional diuretics was evaluated on mean postoperative urine output (MD 0.39, 95% CI 0.17 to 0.61, p=0.006). Tolvaptan co-administered with conventional diuretics significantly increased mean postoperative urine output (MD 0.39) compared to conventional diuretics alone in cardiac surgery patients.
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