Long-term administration of tolvaptan ameliorates annual decline in estimated glomerular filtration rate in outpatients with chronic heart failure

Protective effects of tolvaptan against worsening renal function in acute heart failure have been shown. However, long-term effects of its agent on renal function remain to be elucidated. The present study investigated retrospectively whether long-term treatment with tolvaptan exerts renoprotective...

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Published in:Heart and vessels 2021-08, Vol.36 (8), p.1175-1182
Main Authors: Nakao, Kazuhiro, Horio, Takeshi, Yoshimura, Ryutaro, Fujiwara, Ryosuke, Matsuoka, Yujiro, Yokouchi, Go, Nakamura, Haruo, Sakamoto, Yuya, Fujimoto, Kohei, Izumiya, Yasuhiro, Yoshiyama, Minoru, Kasayuki, Noriaki
Format: Article
Language:English
Subjects:
Antidiuretic Hormone Receptor Antagonists - therapeutic use
Benzazepines
Biomedical Engineering and Bioengineering
Cardiac Surgery
Cardiology
Chronic Disease
Congestive heart failure
Diameters
Diuretics
Epidermal growth factor receptors
Glomerular Filtration Rate
Heart failure
Heart Failure - drug therapy
Humans
Long-term effects
Medicine
Medicine & Public Health
Original Article
Outpatients
Renal failure
Renal function
Retrospective Studies
Tolvaptan - therapeutic use
Vascular Surgery
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Summary:Protective effects of tolvaptan against worsening renal function in acute heart failure have been shown. However, long-term effects of its agent on renal function remain to be elucidated. The present study investigated retrospectively whether long-term treatment with tolvaptan exerts renoprotective effects in patients with chronic heart failure, by comparing serial changes in estimated glomerular filtration rate (eGFR) for years before and after tolvaptan administration. From 63 outpatients with chronic heart failure taking diuretics including tolvaptan, 34 patients whose eGFR levels were continuously measured for more than 6 months both before and after administration of tolvaptan (average dose, 7.8 mg/day at the end of the follow-up period) were selected as eligible for the present analyses. All eGFR values were separately plotted before and after the initiation of treatment with tolvaptan (except hospitalization periods) along the time course axis and the slope of the linear regression curve was calculated as an annual change in eGFR. The mean follow-up periods before and after tolvaptan administration were 1197 and 784 days (3.3 and 2.1 years), respectively. Changing rates of eGFR per year were significantly ameliorated after treatment with tolvaptan (mean ± SD, − 8.02 ± 9.35 to − 1.62 ± 5.09 mL/min/1.73m 2  /year, P  = 0.001). In echocardiographic parameters, inferior vena cava (IVC) diameter significantly decreased after tolvaptan administration, and the decrease in IVC diameter was correlated with the improvement of eGFR decline slope after administration of tolvaptan ( P  = 0.0075). This longitudinal observational study indicated that long-term treatment with tolvaptan ameliorated annual decline in eGFR in outpatients with chronic heart failure. Our findings suggest that tolvaptan has a protective effect against chronically worsening renal function in heart failure patients.
ISSN:0910-8327
1615-2573
DOI:10.1007/s00380-021-01801-6