Abstract
This study aimed to evaluate the use of tolvaptan in a consecutive series of pediatric patients with heart failure. Patients 18 years of age or younger with heart failure prescribed tolvaptan between January 2009 and October 2011 were retrospectively identified at Children’s Medical Center Dallas. Laboratory parameters, urine output, fluid balance, and concurrent medications were recorded at baseline and at specified intervals after a single dose of tolvaptan. The 28 patients in the study had a median age of 2 years (range 1 month–18 years). The median tolvaptan dose administered was 0.3 mg/kg (range 0.1–1.3 mg/kg). The study patients had a median baseline serum sodium concentration of 127 mmol/L, and the increases in sodium were 2.5 mmol/L at 12 h, 5 mmol/L at 24 h, 4 mmol/L at 48 h, and 5 mmol/L at 72 h (all p < 0.001). Urine output was increased at 24 h (p < 0.001) and 48 h (p = 0.03), and fluid balance changes were significantly different at 24 h (p = 0.004). The changes in potassium, blood urea nitrogen, and serum creatinine were not significant at any interval. When controlling for traditional diuretic therapy, increases in serum sodium concentration and urine output remained statistically significant. A single dose of tolvaptan increased serum sodium concentrations for the majority in this small series of pediatric patients with heart failure. These results suggest that tolvaptan can be safely and effectively administered to pediatric patients. Prospective, randomized controlled trials are needed to evaluate the safety and efficacy of its use further.
Similar content being viewed by others
References
Berl T, Quittnat-Pelletier F, Verbalis JG et al (2010) Oral tolvaptan is safe and effective in chronic hyponatremia. J Am Soc Nephrol 21:705–712
Costello-Boerrigter LC, Smith WB, Boerrigter G et al (2006) Vasopressin-2-receptor antagonism augments water excretion without changes in renal hemodynamics or sodium and potassium excretion in human heart failure. Am J Physiol Renal Physiol 290:F273–F278
Decaux G, Soupart A, Vassart G (2008) Non-peptide arginine-vasopressin antagonists: the vaptans. Lancet 371:1624–1632
Gheorghiade M, Niazi I, Ouyang J et al (2003) Vasopressin V2-receptor blockade with tolvaptan in patients with chronic heart failure: results from a double-blind, randomized trial. Circulation 107:2690–2696
Gheorghiade M, Abraham WT, Albert NM et al (2007) Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J 28:980–988
Goldsmith SR (2005) Current treatments and novel pharmacologic treatments for hyponatremia in congestive heart failure. Am J Cardiol 95:14B–23B
Goldsmith SR, Francis GS, Cowley AW Jr et al (1983) Increased plasma arginine vasopressin levels in patients with congestive heart failure. J Am Coll Cardiol 1:1385–1390
Greenberg A (2000) Diuretic complications. Am J Med Sci 319:10–24
Jao GT, Chiong JR (2010) Hyponatremia in acute decompensated heart failure: mechanisms, prognosis, and treatment options. Clin Cardiol 33:666–671
Jones RC, Rajasekaran S, Rayburn M et al (2012) Initial experience with conivaptan use in critically ill infants with cardiac disease. J Pediatr Pharmacol Ther 17:78–83
Kazory A (2010) Hyponatremia in heart failure: revisiting pathophysiology and therapeutic strategies. Clin Cardiol 33:322–329
Konstam MA, Gheorghiade M, Burnett JC Jr et al (2007) Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST outcome trial. JAMA 297:1319–1331
Krumholz HM, Chen Y, Bradford WD et al (1999) Variations in and correlates of length of stay in academic hospitals among patients with heart failure resulting from systolic dysfunction. Am J Manag Care 5:715–723
Lee DS, Austin PC, Rouleau JL et al (2003) Predicting mortality among patients hospitalized for heart failure. JAMA 290:2581–2587
Nemerovski C, Hutchinson DJ (2010) Treatment of hypervolemic or euvolemic hyponatremia associated with heart failure, cirrhosis, or the syndrome of inappropriate antidiuretic hormone with tolvaptan: a clinical review. Clin Ther 32:1015–1032
Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan (2009) Samsca™ (tolvaptan) (package insert)
Rianthavorn P, Cain JP, Turman MA (2008) Use of conivaptan to allow aggressive hydration to prevent tumor lysis syndrome in a pediatric patient with large-cell lymphoma and SIADH. Pediatr Nephrol 23:1367–1370
Sahu R, Balaguru D, Thapar V et al (2012) Conivaptan therapy in an infant with severe hyponatremia and congestive heart failure. Tex Heart Inst J 39:724–726
Schrier RW, Gross P, Gheorghiade M et al (2006) Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N Engl J Med 355:2099–2112
Tribouilloy C, Buiciuc O, Rusinaru D et al (2010) Long-term outcome after a first episode of heart failure: a prospective 7-year study. Int J Cardiol 140:309–314
Yi J, Shin H, Kim H (2011) V2 receptor antagonist, tolvaptan. Electrolyte Blood Press 9:50–54
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Regen, R.B., Gonzalez, A., Zawodniak, K. et al. Tolvaptan Increases Serum Sodium in Pediatric Patients With Heart Failure. Pediatr Cardiol 34, 1463–1468 (2013). https://doi.org/10.1007/s00246-013-0671-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-013-0671-y