Clinical Effectiveness of Tolvaptan in Patients With Acute Heart Failure and Renal Dysfunction. Matsue, Y., Suzuki, M., Torii, S., Yamaguchi, S., Fukamizu, S., Ono, Y., Fujii, H., Kitai, T., Nishioka, T., Sugi, K., Onishi, Y., Noda, M., Kagiyama, N., Satoh, Y., Yoshida, K., & Goldsmith, S. R. Journal of Cardiac Failure, 22(6):423--432, June, 2016.
Clinical Effectiveness of Tolvaptan in Patients With Acute Heart Failure and Renal Dysfunction [link]Paper  doi  abstract   bibtex   
Background More efficacious and/or safer decongestive therapy is clearly needed in acute heart failure (AHF) patients complicated by renal dysfunction. We tested the hypothesis that adding tolvaptan, an oral vasopressin-2 receptor antagonist, to conventional therapy with loop diuretics would be more effective treatment in this population. Methods and Results A multicenter, open-label, randomized control trial was performed, and 217 AHF patients with renal dysfunction (estimated glomerular filtration rate 15–60 mL • min−1 • 1.73 m−2) were randomized 1:1 to treatment with tolvaptan (n = 108) or conventional treatment (n = 109). The primary end point was 48-hour urine volume. The tolvaptan group showed more diuresis than the conventional treatment group (6464.4 vs 4999.2 mL; P \textless .001) despite significantly lower amounts of loop diuretic use (80 mg vs 120 mg; P \textless .001). Dyspnea relief was achieved significantly more frequently in the tolvaptan group at all time points within 48 hours except 6 hours after enrollment. The rate of worsening of renal function (≥0.3 mg/dL increase from baseline) was similar between the tolvaptan and conventional treatment groups (24.1% vs 27.8%, respectively; P = .642). Conclusions Adding tolvaptan to conventional treatment achieved more diuresis and relieved dyspnea symptoms in AHF patients with renal dysfunction. Clinical Trial Registration URL: http://www.umin.ac.jp/ctr/index/htm/ Unique identifier: UMIN000007109
@article{matsue_clinical_2016,
	title = {Clinical {Effectiveness} of {Tolvaptan} in {Patients} {With} {Acute} {Heart} {Failure} and {Renal} {Dysfunction}},
	volume = {22},
	issn = {1071-9164, 1532-8414},
	url = {http://www.onlinejcf.com/article/S1071-9164(16)00067-1/abstract},
	doi = {10.1016/j.cardfail.2016.02.007},
	abstract = {Background
More efficacious and/or safer decongestive therapy is clearly needed in acute heart failure (AHF) patients complicated by renal dysfunction. We tested the hypothesis that adding tolvaptan, an oral vasopressin-2 receptor antagonist, to conventional therapy with loop diuretics would be more effective treatment in this population.
Methods and Results
A multicenter, open-label, randomized control trial was performed, and 217 AHF patients with renal dysfunction (estimated glomerular filtration rate 15–60 mL • min−1 • 1.73 m−2) were randomized 1:1 to treatment with tolvaptan (n = 108) or conventional treatment (n = 109). The primary end point was 48-hour urine volume. The tolvaptan group showed more diuresis than the conventional treatment group (6464.4 vs 4999.2 mL; P {\textless} .001) despite significantly lower amounts of loop diuretic use (80 mg vs 120 mg; P {\textless} .001). Dyspnea relief was achieved significantly more frequently in the tolvaptan group at all time points within 48 hours except 6 hours after enrollment. The rate of worsening of renal function (≥0.3 mg/dL increase from baseline) was similar between the tolvaptan and conventional treatment groups (24.1\% vs 27.8\%, respectively; P = .642).
Conclusions
Adding tolvaptan to conventional treatment achieved more diuresis and relieved dyspnea symptoms in AHF patients with renal dysfunction.
Clinical Trial Registration
URL: http://www.umin.ac.jp/ctr/index/htm/ Unique identifier: UMIN000007109},
	language = {English},
	number = {6},
	urldate = {2016-10-10TZ},
	journal = {Journal of Cardiac Failure},
	author = {Matsue, Yuya and Suzuki, Makoto and Torii, Sho and Yamaguchi, Satoshi and Fukamizu, Seiji and Ono, Yuichi and Fujii, Hiroyuki and Kitai, Takeshi and Nishioka, Toshihiko and Sugi, Kaoru and Onishi, Yuko and Noda, Makoto and Kagiyama, Nobuyuki and Satoh, Yasuhiro and Yoshida, Kazuki and Goldsmith, Steven R.},
	month = jun,
	year = {2016},
	pmid = {26915749},
	keywords = {Acute heart failure, Renal function, Vasopressin antagonist},
	pages = {423--432}
}
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