イシダ　イツセイ   Ishida Itsusei   石田　一世    所属   医学部 医学科（東京女子医科大学病院）    職種   助教
言語種別	英語
発表タイトル	High BUN is a Good Candidate for Early Start of Tolvaptan in Patients with Congestive Heart Failure
会議名	The 79th Annual Scientific Meeting of the Japanese Circulation Society
主催者	Japanese Circulation Society
学会区分	全国規模の学会
発表形式	ポスター掲示
講演区分	一般
発表者・共同発表者	◎JUJO Kentaro, KIM Ahsung, ISHIDA Issei, SUZUKI Yuki, SAITO Katsumi, HAGIWARA Nobuhisa
発表年月日	2015/04/24
開催地 （都市, 国名）	Osaka, JAPAN
概要	BACKGROUNDS: High BUN values on admission in congestive heart failure (CHF) patients related with poor prognosis regardless of furosemide dose. Tolvaptan, vasopressin 2 receptor antagonist, is a potential alternative diuretics to decrease BUN via anti-reabsorption effect of urea in collecting duct, however, appropriate timing of initiation of this drug is still under discussion. METHODS and RESULTS: Total of 91 consecutive patients hospitalized due to worsening of CHF and treated with additional 7.5 mg of oral Tolvaptan was retrospectively analyzed. The average duration from admission to tolvaptan initiation (TIMEAT) was 4.3 days, and overall average peak daily urine volume (UV) during tolvaptan administration was 2,554±1,247 mL/day. A peak daily UV had no obvious correlation either with TIMEAT, serum creatinine, blood pressure (BP) or BUN at baseline in whole patients. However, once classified by baseline BP under the Clinical Scenarios criteria, in patients with higher BP at baseline, peak UV showed a negative relationship with TIMEAT (r2=0.24, p=0.053). Moreover, higher BUN more than 30 mg/dL at baseline had significantly negative association with TIMEAT, yet low BUN did not (r2=0.17, p=0.011, r2<0.01, p=1.0, respectively). Consistently, in CHF patients with a combination of high BUN and preserved BP, peak UV had a potent relationship with TIMEAT (r2=0.20, p=0.014).CONCLUSION: CHF patients with baseline high BUN could be good candidates for early start of tolvaptan.