ISHIDA Issei    Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine    Position   Assistant Professor
Language	English
Title	High BUN is a Good Candidate for Early Start of Tolvaptan in Patients with Congestive Heart Failure
Conference	The 79th Annual Scientific Meeting of the Japanese Circulation Society
Promoters	Japanese Circulation Society
Conference Type	Nationwide Conferences
Presentation Type	Poster notice
Lecture Type	General
Publisher and common publisher	◎JUJO Kentaro, KIM Ahsung, ISHIDA Issei, SUZUKI Yuki, SAITO Katsumi, HAGIWARA Nobuhisa
Date	2015/04/24
Venue (city and name of the country)	Osaka, JAPAN
Summary	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.