ハギワラ　ノブヒサ   Nobuhisa Hagiwara   萩原　誠久    所属   その他 その他    職種   非常勤嘱託
論文種別	原著
言語種別	英語
査読の有無	査読あり
招待の有無	招待あり
表題	Good response to tolvaptan shortens hospitalization in patients with congestive heart failure.
掲載誌名	正式名：Heart and vessels 略　 称：Heart Vessels ISSNコード：0910-8327/1615-2573
掲載区分	国外
出版社	Springer Japan
巻・号・頁	33(4),pp.374-383
著者・共著者	KOGURE Tomohito†, JUJO Kentaro*, HAMADA Kazuyuki, SAITO Katsumi, HAGIWARA Nobuhisa
担当区分	最終著者
発行年月	2018/04
概要	Tolvaptan has been gradually spread to use as a potent diuretic for congestive heart failure in the limited country. However, the response to this aquaretic drug still is unpredictable. A total of 92 patients urgently hospitalized due to congestive heart failure and treated with tolvaptan in addition to standard treatment was retrospectively analyzed. Responder of tolvaptan treatment was defined as a patient with peak negative fluid balance greater than 500 mL/day, and clinical profiles were compared between 76 responders and 16 non-responders. Responders started to increase daily urine volume (UV) from Day 1 through Day 3. In contrast, non-responders showed no significant increase in daily UV from the baseline up to Day 5. Time between admission and tolvaptan administration was shorter in responders, even without statistical significance (3.3 vs. 4.6 days, p = 0.053). Multivariate analysis revealed that blood urea nitrogen (BUN) [cutoff: 34 mg/dL, odds ratio (OR) 9.0, 95% confidence interval (CI) 1.42-57.3, p < 0.01] and plasma renin activity (PRA) (cutoff: 4.7 ng/mL/h, OR 6.1, 95% CI 1.01-36.4, p < 0.01) at baseline were independent predictors for tolvaptan responsiveness. It suggests that renal perfusion may affect tolvaptan-induced UV. Finally, durations of stay in intensive care unit and total hospitalization were significantly shorter in responders (median: 6.0 vs. 13.0 days, p = 0.022; 15.0 vs. 25.0 days, p = 0.016, respectively). Responders of tolvaptan have lower BUN and renin activity at baseline, and shorten hospitalization period. Trial Registration The study was registered at University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) with the identifier UMIN000023594. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000024988.
DOI	10.1007/s00380-017-1072-6
PMID	29128962