Novel Risk Score Efficiently Prevents Tolvaptan-Induced Hypernatremic Events in Patients With Heart Failure
Novel Risk Score Efficiently Prevents Tolvaptan-Induced Hypernatremic Events in Patients With Heart Failure
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DOI：
10.1253/circj.cj-17-0986
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发表时间：
2018-05-01
影响因子：
3.3
通讯作者：
Shimakawa, Toshiyuki
中科院分区：
文献类型：
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作者：
Kinugawa, Koichiro;Sato, Naoki;Shimakawa, Toshiyuki
背景：托伐普坦在日本被批准用于容量超负荷患者的心力衰竭适应症已有7年了；该药可用于正常钠血症患者。高钠血症被确定为需要预防的重大不良事件。方法和结果：我们汇编并分析了 5 年多的 3,349 名患者的数据，以确定接受托伐普坦治疗的高钠血症风险的患者。高钠血症（定义为血清钠≥150 mEq/L）的发生率为3.65%。基线血清钠浓度、血清钾浓度、血尿素氮：肌酐比、托伐普坦初始剂量和年龄被确定为高钠血症的危险因素。使用这些因素的比值比制定高钠血症风险评分。高风险人群被定义为风险评分>= 17.80的患者。结论：为了防止服用托伐普坦的患者发生高钠血症事件，我们建议使用我们的新评分流程确定为高钠血症高风险的患者使用非常低的起始剂量（即3.75毫克/天）。
Background: It has been 7 years since tolvaptan was approved in Japan for the indication of heart failure in patients with volume overload; the drug can be used in patients with normonatremia. Hypernatremia was identified as a significant adverse event to be prevented.Methods and Results: We compiled and analyzed data from 3,349 patients over 5 years to identify patients at high risk of hypernatremia with tolvaptan treatment. The incidence of hypernatremia, defined as serum sodium >= 150 mEq/L, was 3.65%. Baseline serum sodium concentrations, serum potassium concentrations, blood urea nitrogen : creatinine ratio, initial tolvaptan dose, and age were identified as risk factors for hypernatremia. A hypernatremia risk score was developed using the odds ratios for these factors. The high-risk population was defined as patients with a risk score >= 17.80.Conclusions: To prevent the occurrence of hypernatremic events in patients taking tolvaptan, we recommend a very low starting dose (i.e., 3.75 mg/day) in patients identified as being at high risk of hypernatremia using our new scoring process.