Novel criteria of urine osmolality effectively predict response to tolvaptan in decompensated heart failure patients-association between non-responders and chronic kidney disease

DOI Web Site PubMed 被引用文献48件 参考文献31件
  • Imamura Teruhiko
    Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
  • Kinugawa Koichiro
    Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
  • Shiga Taro
    Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
  • Kato Naoko
    Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
  • Muraoka Hironori
    Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
  • Minatsuki Shun
    Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
  • Inaba Toshiro
    Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
  • Maki Hisataka
    Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
  • Hatano Masaru
    Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
  • Yao Atsushi
    Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
  • Kyo Shunei
    Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
  • Nagai Ryozo
    Jichi Medical University

書誌事項

タイトル別名
  • Novel Criteria of Urine Osmolality Effectively Predict Response to Tolvaptan in Decompensated Heart Failure Patients
  • – Association Between Non-Responders and Chronic Kidney Disease –

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抄録

Background: A newly-developed vasopressin type 2 receptor antagonist, tolvaptan (TLV), has a unique feature of diuresis, but the response to this drug can be unpredictable. Methods and Results: Data were collected from hospitalized patients with decompensated congestive heart failure who were administered TLV at 3.75–15mg/day (n=61). A responder/non-responder to TLV was determined as having any increase/decrease in urine volume (UV) during the next 24h after TLV treatment on the first day. Logistic regression analyses for increases in UV were performed, and independent predictors of the responder were the following: C1, baseline urine osmolality (U-OSM) >352mOsm/L; and C2, %decrease in U-OSM >26% at 4–6h after TLV administration. Criteria consisting of C1 and C2 had a good predictability for responders by receiver-operating characteristic analysis (area under the curve=0.960). Kidneys of the non-responders no longer had diluting ability (%decrease of U-OSM at 4–6h=2.7±14.6%*), but also barely kept concentrating ability (baseline U-OSM=296.4±68.7*mOsm/L) with markedly reduced estimated glomerular filtration ratio (35.5±29.4ml·min–1·1.73m−2*) (*P<0.05 vs. patients who had at least 1 positive condition [n=42]). Conclusions: More than 26% decrease in U-OSM from a baseline >352mOsm/L for the first 4–6h predicts responders to TLV. Unresponsiveness to TLV is attributable to nephrogenic diabetes insipidus complicated by chronic renal disease.  (Circ J 2013; 77: 397–404)<br>

収録刊行物

  • Circulation Journal

    Circulation Journal 77 (2), 397-404, 2013

    一般社団法人 日本循環器学会

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