Mechanisms of Diuresis for Acute Decompensated Heart Failure by Tolvaptan
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- Nomoto Hidetsugu
- Department of Cardiovascular Medicine, National Hospital Organization, Disaster Medical Center Department of Cardiovascular Medicine, Tokyo Medical and Dental University
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- Satoh Yasuhiro
- Department of Cardiovascular Medicine, National Hospital Organization, Disaster Medical Center
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- Kamiyama Mayu
- Department of Cardiovascular Medicine, National Hospital Organization, Disaster Medical Center
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- Yabe Kento
- Department of Cardiovascular Medicine, National Hospital Organization, Disaster Medical Center
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- Masumura Mayumi
- Department of Cardiovascular Medicine, National Hospital Organization, Disaster Medical Center
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- Sakakibara Atsushi
- Department of Cardiovascular Medicine, National Hospital Organization, Disaster Medical Center
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- Yamashita Shu
- Department of Cardiovascular Medicine, National Hospital Organization, Disaster Medical Center
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- Suzuki Masahito
- Department of Cardiovascular Medicine, National Hospital Organization, Disaster Medical Center
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- Sugiyama Tomoyo
- Department of Cardiovascular Medicine, National Hospital Organization, Disaster Medical Center
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- Oumi Tetsuo
- Department of Cardiovascular Medicine, National Hospital Organization, Disaster Medical Center
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- Ohno Masakazu
- Department of Cardiovascular Medicine, National Hospital Organization, Disaster Medical Center
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- Takahashi Yoshihide
- Department of Cardiovascular Medicine, National Hospital Organization, Disaster Medical Center
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- Isobe Mitsuaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
書誌事項
- タイトル別名
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- Assessment by Bioelectrical Impedance Analysis
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抄録
<p>Tolvaptan, a vasopressin type 2 receptor antagonist, does not affect kidney circulation or cause worsening of renal function (WRF) in patients with acute decompensated heart failure (ADHF). Bioelectrical impedance analysis (BIA) can be used to evaluate intravascular volume by calculating the ratio of extracellular water (ECW) to intracellular water (ICW). There have been no reports examining the mechanisms of tolvaptan-induced diuresis using BIA. We investigated whether tolvaptan decreases excess volume while maintaining intravascular volume in ADHF patients.</p><p>Study patients included 29 ADHF patients (age 48-95, men 69%) diagnosed between April 2013 and May 2016 and who underwent BIA before and after treatment. Fifteen patients were treated with tolvaptan in addition to conventional diuresis therapy (tolvaptan group), and 14 patients were treated with conventional diuresis therapy only (control group). In the control group, the numerical value of serum creatinine (Cre) significantly increased from 0.89 ± 0.22 mg/ dL to 1.07 ± 0.29 mg/dL (P = 0.004), and the ECW/ICW significantly decreased from 0.696 ± 0.036 to 0.673 ± 0.032 (P = 0.004). These values were not significantly different from those obtained for the tolvaptan group. Furthermore, regression analysis showed a negative correlation between ΔCre and ΔECW/ICW, which are the differences between values before and after treatment (ΔCre = -0.002-5.668 × ΔECW/ICW, r2 = 0.306, P = 0.002).</p><p>Our findings suggest that WRF is caused by a reduction in intravascular volume and that tolvaptan treatment can decrease the excess volume while maintaining intravascular volume.</p>
収録刊行物
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- International Heart Journal
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International Heart Journal 58 (4), 593-600, 2017
一般社団法人 インターナショナル・ハート・ジャーナル刊行会
