Heart and Vessels

, Volume 33, Issue 4, pp 374–383 | Cite as

Good response to tolvaptan shortens hospitalization in patients with congestive heart failure

  • Tomohito Kogure
  • Kentaro Jujo
  • Kazuyuki Hamada
  • Katsumi Saito
  • Nobuhisa Hagiwara
Original Article


Tolvaptan has been gradually spread to use as a potent diuretic for congestive heart failure in the limited country. However, the response to this aquaretic drug still is unpredictable. A total of 92 patients urgently hospitalized due to congestive heart failure and treated with tolvaptan in addition to standard treatment was retrospectively analyzed. Responder of tolvaptan treatment was defined as a patient with peak negative fluid balance greater than 500 mL/day, and clinical profiles were compared between 76 responders and 16 non-responders. Responders started to increase daily urine volume (UV) from Day 1 through Day 3. In contrast, non-responders showed no significant increase in daily UV from the baseline up to Day 5. Time between admission and tolvaptan administration was shorter in responders, even without statistical significance (3.3 vs. 4.6 days, p = 0.053). Multivariate analysis revealed that blood urea nitrogen (BUN) [cutoff: 34 mg/dL, odds ratio (OR) 9.0, 95% confidence interval (CI) 1.42–57.3, p < 0.01] and plasma renin activity (PRA) (cutoff: 4.7 ng/mL/h, OR 6.1, 95% CI 1.01–36.4, p < 0.01) at baseline were independent predictors for tolvaptan responsiveness. It suggests that renal perfusion may affect tolvaptan-induced UV. Finally, durations of stay in intensive care unit and total hospitalization were significantly shorter in responders (median: 6.0 vs. 13.0 days, p = 0.022; 15.0 vs. 25.0 days, p = 0.016, respectively). Responders of tolvaptan have lower BUN and renin activity at baseline, and shorten hospitalization period.

Trial Registration

The study was registered at University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) with the identifier UMIN000023594.


Heart failure Diuretic Tolvaptan Renal function 



We would like to thank Editage ( for English language editing.

Compliance with ethical standards

Conflict of interest

This study was not financially supported from any company, grant or fund, and all authors have no conflict of interest.

Supplementary material

380_2017_1072_MOESM1_ESM.docx (36.2 mb)
Supplementary material 1 (DOCX 37041 kb)


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Copyright information

© Springer Japan KK 2017

Authors and Affiliations

  • Tomohito Kogure
    • 1
  • Kentaro Jujo
    • 1
  • Kazuyuki Hamada
    • 1
  • Katsumi Saito
    • 2
  • Nobuhisa Hagiwara
    • 1
  1. 1.Department of CardiologyTokyo Women’s Medical UniversityTokyoJapan
  2. 2.Department of CardiologyNishiarai Heart Center HospitalTokyoJapan

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