Renoprotective Benefit of Tolvaptan in Acute Decompensated Heart Failure Patients With Loop Diuretic-Resistant Status.
Renoprotective Benefit of Tolvaptan in Acute Decompensated Heart Failure Patients With Loop Diuretic-Resistant Status.
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DOI：
10.14740/jocmr3671
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发表时间：
2019-01-01
期刊：
影响因子：
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通讯作者：
Urata, Hidenori
中科院分区：
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作者：
Yamamoto, Tomohiko;Miura, Shin-Ichiro;Urata, Hidenori
背景技术背景：虽然使用袢利尿剂减少积聚的体液是急性心力衰竭（AHF）的常用治疗选择，但一些患者，尤其是慢性肾脏疾病（CKD）患者，对袢利尿剂的治疗反应明显较差。托伐普坦（TLV）在几项研究中显示出对AHF的有效性。我们一直使用TLV治疗AHF，即使在CKD患者中也显示出良好的结局。本研究的目的是评估TLV在AHF患者的治疗效果。患者分为两组：TLV治疗组（TLV组，n = 39）和常规治疗组（非TLV组，n = 60）。回顾性分析TLV联合治疗对肾功能不全并发症和袢利尿剂耐药的AHF患者的疗效，并对射血分数保留（HFpEF）或射血分数降低（HFrEF）的心力衰竭患者进行详细分析。尽管TLV组患者基线时的估计肾小球滤过率（eGFR）显著较低，表明肾功能不全可能是由于袢利尿剂剂量较高所致，但HFpEF中肾功能恶化（WRF）的发生率显著低于非TLV组（TLV：2.5% vs. non-TLV：15.4%，P = 0.01）。Logistic回归分析发现TLV是降低WRF的独立因素（OR：0.14，95%CI：0.02 ~ 0.98，P = 0.04）。结论：急性期应用TLV对CKD合并AHF患者具有肾脏保护作用，尤其是HFpEF患者。
BACKGROUND: While reduction of accumulated body fluid using loop diuretics is a commonly used therapeutic option for acute heart failure (AHF), some patients, especially those with chronic kidney disease (CKD), show significantly poor treatment response to loop diuretics. Tolvaptan (TLV) has shown effectiveness against AHF in several studies. We have been using TLV for AHF treatment, and it displayed favorable outcome even in patients with CKD. This study aimed to assess the therapeutic effectiveness of TLV in AHF patients.METHODS: Ninety-nine AHF patients who were hospitalized were assessed retrospectively. Patients were divided into two groups: TLV treatment (TLV group, n = 39) and conventional treatment (non-TLV group, n = 60). We retrospectively examined the efficacy of TLV combination therapy for renal insufficiency complications and loop diuretic-resistant AHF patients, and the detail analysis was performed for heart failure with preserved ejection fraction (HFpEF) or reduced ejection fraction (HFrEF) in patients.RESULTS: Changes in serum electrolyte levels before and after the treatment were similar in both groups. Although the patients in the TLV group at baseline displayed significantly lower estimated glomerular filtration rate (eGFR) indicating renal insufficiency probably due to higher dose of loop diuretics, the incidence of worsening renal function (WRF) was significantly lower than those in non-TLV group in HFpEF (TLV: 2.5% vs. non-TLV: 15.4%, P = 0.01). We performed logistic regression analysis and found that TLV was an independent contributing factor for reducing WRF (odds ratio: 0.14, 95% CI: 0.02 - 0.98, P = 0.04).CONCLUSIONS: Our results suggest that TLV application in acute stage may be renoprotective for AHF patients with CKD, especially in HFpEF.