AIM To observe the efficacy of tolvaptan in patients with acute ejection fraction-reduced heart failure complicated with renal dysfunction.
METHODS A total of 60 patients with acute heart failure and renal dysfunction eGFR(15～60) mL/（min·1.73m2） in the Cardiovascular Intensive Care Unit of the First Affiliated Hospital of Air Force Medical University were divided into two groups. Conventional treatment of acute heart failure was applied in control group and Tovaptan was added to conventional treatment of acute heart failure in experimental group. Forty-eight-hour urine output, dosage of loop diuretics, improvement of dyspnea, edema of both lower extremities and the changes of Cr, BUN, eGFR and NT-proBNP were observed in both groups.
RESULTS Compared with the control group, the primary end point (48h urine volume) in the tolvaptan group was significantly increased (6 506 ± 454) mL vs. (4 630 ± 273) mL, P<0.01. In the secondary end point, the total amount of loop diuretics in the Tuvaptan group at 48 hours was lower than that in the control group (102 ± 15) mg vs. (166 ± 19) mg, P<0.01). Edema, dyspnea and other indicators were significantly improved in the Tuvastan group and the control group, both P<0.01, but there was no statistical difference between the two groups. Cr and BUN values in the two groups showed a downward trend, creatinine (Cr) and urea (BUN) values in the Tovapram group decreased more significantly, and eGFR values in the Tovapram group increased more significantly, both P<0.01. The incidence of adverse events of low sodium and low potassium in the Tuvaptan group and the control group was 3% vs. 10%, P<0.05. After 90 days of follow-up, the readmission rate and fatality rate of the two groups were 13% vs. 17%, with no statistical difference.
CONCLUSION Tolvaptan can increase urine volume, improve congestion symptoms such as dyspnea and edema of both lower limbs in acute heart failure patients with renal insufficiency, increase blood sodium level and reduce renal function damage.
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