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Administration of tolvaptan with reduction of loop diuretics ameliorates congestion with improving renal dysfunction in patients with congestive heart failure and renal dysfunction

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Abstract

In patients with congestive heart failure and renal dysfunction, high dose of diuretics are necessary to improve congestion, which may progress to renal dysfunction. We examined the efficacy of tolvaptan with reduction of loop diuretics to improve renal function in patients with congestive heart failure and renal dysfunction. We conducted a multicenter, prospective, randomized study in 44 patients with congestive heart failure and renal dysfunction (serum creatinine concentration ≥1.1 mg/dl) treated with conventional diuretics. Patients were randomly divided into two groups: tolvaptan (15 mg) with a fixed dose of diuretics or with reducing to a half-dose of diuretics for 7–14 consecutive days. We examined the change of urine volume, body weight, serum creatinine and electrolyte concentrations in each group. Both groups demonstrated significant urine volume increase (724 ± 176 ml/day in the fixed-dose group and 736 ± 114 ml/day in the half-dose group) and body weight reduction (1.6 ± 1.5 kg and 1.6 ± 1.9 kg, respectively) from baseline, with no differences between the two groups. Serum creatinine concentration was significantly increased in the fixed-dose group (from 1.60 ± 0.47 to 1.74 ± 0.66 mg/dl, p = 0.03) and decreased in the half-dose group (from 1.98 ± 0.91 to 1.91 ± 0.97 mg/dl, p = 0.10). So the mean changes in serum creatinine concentration from baseline significantly differed between the two groups (0.14 ± 0.08 mg/dl in the fixed-dose group and −0.07 ± 0.19 mg/dl in the half-dose group, p = 0.006). The administration of tolvaptan with reduction of loop diuretics was clinically effective to ameliorate congestion with improving renal function in patients with congestive heart failure and renal dysfunction.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan

    Akihisa Hanatani, Atsushi Shibata, Ryouko Kitada, Shinichi Iwata, Yoshiki Matsumura, Atsushi Doi, Kenichi Sugioka, Masahiko Takagi & Minoru Yoshiyama

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  1. Akihisa Hanatani
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  2. Atsushi Shibata
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  3. Ryouko Kitada
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  4. Shinichi Iwata
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  5. Yoshiki Matsumura
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  7. Kenichi Sugioka
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  8. Masahiko Takagi
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  9. Minoru Yoshiyama
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Correspondence to Akihisa Hanatani.

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Appendix

Appendix

This study was conducted in the following institutions: Osaka City General Hospital, Bell Land General Hospital, Ishikiriseiki Hospital, Asakayama General Hospital, Osaka Ekisaikai Hospital, Izumi Municipal Hospital and Higashisumiyoshi Morimoto Hospital.

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Hanatani, A., Shibata, A., Kitada, R. et al. Administration of tolvaptan with reduction of loop diuretics ameliorates congestion with improving renal dysfunction in patients with congestive heart failure and renal dysfunction. Heart Vessels 32, 287–294 (2017). https://doi.org/10.1007/s00380-016-0872-4

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