Key result
In heart failure patients with residual congestion and renal dysfunction refractory to standard therapy, additive tolvaptan significantly increased urine volume without further renal impairment compared to an increased dose of furosemide.
Why the study?
Does additive tolvaptan improve urine output and prevent worsening renal function compared to increased furosemide in heart failure patients with diuretic resistance and renal impairment?
RCT (n=81)
Open-label
Randomized
Yes
Does additive tolvaptan improve urine output and prevent worsening renal function compared to increased furosemide in heart failure patients with diuretic resistance and renal impairment?
p-value: p=0.0003
In heart failure patients with diuretic resistance and renal impairment, adding tolvaptan effectively increased urine output without causing further renal impairment compared to increasing the dose of furosemide.
Supports adding tolvaptan over furosemide escalation in refractory cardiorenal HF; extends RCT evidence for aquaresis without renal worsening.
BACKGROUND: Although diuretic resistance leading to residual congestion is a known predictor of a poorer heart failure (HF) prognosis, better therapeutic strategies for effective and safe decongestion have not been established. METHODS AND RESULTS: , were randomized into 2 groups and administered either ≤15 mg/day additive tolvaptan (TLV) or ≤40 mg/day increased FUR for 7 days. Changes in urine volume between baseline and mean urine volume during treatment were significantly higher in the TLV than FUR group (P=0.0003). Although there was no significant decrease in body weight or improved signs and symptoms of congestion between the 2 groups, the increase in serum creatinine on Day 7 from baseline was significantly smaller in the TLV than FUR group (P=0.038). Multiple logistic regression analysis revealed that additive TLV (odds ratio 0.157, 95% confidence interval 0.043-0.605, P=0.001) was an independent clinical factor for improved renal function during treatment compared with increased FUR. CONCLUSIONS: In HF patients with residual congestion and renal dysfunction refractory to standard therapy, additive TLV increased urine volume without further renal impairment compared with patients who received an increased dose of FUR.
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Inomata et al. (2017) conducted an RCT in Heart failure with diuretic resistance and renal impairment (n=81). Tolvaptan vs. Increased furosemide (≤40 mg/day) was evaluated on Average change in urine output during the treatment period for 7 days or less compared with baseline values (p=0.0003). In heart failure patients with residual congestion and renal dysfunction refractory to standard therapy, additive tolvaptan significantly increased urine volume without further renal impairment compared to an increased dose of furosemide.
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