open access

Vol 23, No 5 (2016)
CLINICAL CARDIOLOGY Original articles
Published online: 2016-08-01
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Association between plasma concentration of tolvaptan and urine volume in acute decompensated heart failure patients with fluid overload

Mahoto Kato, Kazuto Tohyama, Toshiyuki Ohya, Takafumi Hiro, Atsushi Hirayama
DOI: 10.5603/CJ.a2016.0055
·
Pubmed: 27515480
·
Cardiol J 2016;23(5):497-504.

open access

Vol 23, No 5 (2016)
CLINICAL CARDIOLOGY Original articles
Published online: 2016-08-01

Abstract

Background: Tolvaptan (TLV) is a useful diuretic for acute decompensated heart failure (ADHF) with fluid overload, but its clinical response varies between patients. The aim of this study is to investigate whether plasma TLV concentrations correlate with the urine volume.

Methods: ADHF inpatients with evidence of fluid overload and total urine volume < 1,500 mL 24 h after initial intravenous administration of 40 mg furosemide were included in the study. On days 1–7, 7.5 mg oral TLV was added. The plasma TLV concentration, plasma renin activity (PRA), and plasma aldosterone concentration (PAC) were measured on days 1, 3 and 7.

Results: In the 52 patients who completed the protocol, the TLV concentration increased significantly from 67.6 ± 30.1 ng/mL on day 1 to 98.3 ± 39.6 ng/mL on day 3 to 144.8 ± 44.2 ng/mL on day 7, and the TLV concentration correlated with total urine volume on days 3 and 7 (r = 0.392, p < 0.01; r = 0.639, p < 0.001, respectively) but not on day 1. The urine volume correlated inversely with PRA and PAC (r = −0.618, p < 0.05; r = −0.547, p < 0.05, respectively).

Conclusions: Plasma TLV concentrations correlated with the urine volume in late phase of treatment but not in early phase, which suggests that the effect of TLV may possibly be inhibited by renin–angiotensin–aldosterone system activity.

Abstract

Background: Tolvaptan (TLV) is a useful diuretic for acute decompensated heart failure (ADHF) with fluid overload, but its clinical response varies between patients. The aim of this study is to investigate whether plasma TLV concentrations correlate with the urine volume.

Methods: ADHF inpatients with evidence of fluid overload and total urine volume < 1,500 mL 24 h after initial intravenous administration of 40 mg furosemide were included in the study. On days 1–7, 7.5 mg oral TLV was added. The plasma TLV concentration, plasma renin activity (PRA), and plasma aldosterone concentration (PAC) were measured on days 1, 3 and 7.

Results: In the 52 patients who completed the protocol, the TLV concentration increased significantly from 67.6 ± 30.1 ng/mL on day 1 to 98.3 ± 39.6 ng/mL on day 3 to 144.8 ± 44.2 ng/mL on day 7, and the TLV concentration correlated with total urine volume on days 3 and 7 (r = 0.392, p < 0.01; r = 0.639, p < 0.001, respectively) but not on day 1. The urine volume correlated inversely with PRA and PAC (r = −0.618, p < 0.05; r = −0.547, p < 0.05, respectively).

Conclusions: Plasma TLV concentrations correlated with the urine volume in late phase of treatment but not in early phase, which suggests that the effect of TLV may possibly be inhibited by renin–angiotensin–aldosterone system activity.

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Keywords

tolvaptan, selective vasopressin type 2 receptor antagonist, plasma concentration, renin-angiotensin-aldosterone system, acute decompensated heart failure

About this article
Title

Association between plasma concentration of tolvaptan and urine volume in acute decompensated heart failure patients with fluid overload

Journal

Cardiology Journal

Issue

Vol 23, No 5 (2016)

Pages

497-504

Published online

2016-08-01

DOI

10.5603/CJ.a2016.0055

Pubmed

27515480

Bibliographic record

Cardiol J 2016;23(5):497-504.

Keywords

tolvaptan
selective vasopressin type 2 receptor antagonist
plasma concentration
renin-angiotensin-aldosterone system
acute decompensated heart failure

Authors

Mahoto Kato
Kazuto Tohyama
Toshiyuki Ohya
Takafumi Hiro
Atsushi Hirayama

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