Renoprotective effect of tolvaptan in patients with new-onset acute heart failure

Abstract

Aims: Although tolvaptan has been reported to prevent worsening renal function (WRF) in patients with advanced acute heart failure (AHF), evidence regarding the effect of tolvaptan on renal function in patients with new-onset AHF is not available. This study aimed to investigate the renoprotective effect of tolvaptan in patients hospitalized with new-onset AHF.

Methods and results: A total of 122 consecutive patients hospitalized with new-onset AHF between May 2015 and December 2018 were retrospectively evaluated. WRF was defined as an absolute increase in serum creatinine ≥0.3 mg/dL (≥26.4 μmol/L) within 48 h or a 1.5-fold increase in serum creatinine after hospitalization. The furosemide group (n = 75) and the tolvaptan add-on group (n = 47) were compared. The tolvaptan group consists of patients who received tolvaptan as an individual physicians' decision. The incidence of WRF was significantly lower in the tolvaptan add-on group (8.5%) than in the furosemide group (24.0%, P = 0.03). Multivariate logistic regression analysis revealed that tolvaptan treatment was an independent variable related to the prevention of WRF [odds ratio (OR), 0.20; 95% confidence interval (CI), 0.05-0.85]. Furthermore, subgroup analysis revealed a more favourable effect of tolvaptan in patients with serum creatinine ≥1.1 mg/dL on admission (OR, 0.23; 95% CI, 0.06-0.98) and an ejection fraction <50% (OR, 0.19; 95% CI, 0.04-0.90).

Conclusions: A lower incidence of WRF was observed in patients with new-onset AHF who were treated with the tolvaptan add-on therapy, specifically those with left ventricular systolic dysfunction and renal impairment on admission.

Keywords: Acute heart failure; Tolvaptan; Worsening renal function.

Figure 1

Study flow chart. AHF, acute heart failure; NYHA, New York Heart Association functional.

Figure 2

Change in systolic and diastolic blood pressures during hospitalization. ^* P < 0.05, compared with the furosemide group. BP, blood pressure.

Figure 3

Incidence of worsening renal function.

Figure 4

Forrest plot of odds ratios by pre‐specified patient subgroups for the incidence of worsening renal function. CI, confidence interval; Cr, creatinine; EF, ejection fraction; OR, odds ratio; SBP, systolic blood pressure.