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Are there differences in the effect of Tolvaptan depending on the renal function? results of clinical experience

Session Poster session 1 Saturday 08:30 -17:30

Speaker Nahikari Salterain Gonzalez

Congress : Heart Failure 2015

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure
  • Session type : Poster Session
  • FP Number : P256

Authors : N Salterain Gonzalez (Pamplona,ES), A Esteban Fernandez (Pamplona,ES), FJ Lavilla Royo (Pamplona,ES), JJ Gavira Gomez (Pamplona,ES)

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Authors:
N Salterain Gonzalez1 , A Esteban Fernandez1 , FJ Lavilla Royo2 , JJ Gavira Gomez1 , 1University of Navarra, Cardiology - Pamplona - Spain , 2University of Navarra, Nephrology - Pamplona - Spain ,

Citation:
European Journal of Heart Failure Abstracts Supplement ( 2015 ) 17 ( Supplement 1 ), 53

Purpose: Tolvaptan, a vasopressin receptor antagonist has been accepted as a therapeutic alternative for refractory hyponatremia treatment in heart failure (HF) patients. We aimed to assess differences in Tolvaptan response according to renal function.

Methods: We reviewed data from all patients admitted for HF and refractory hyponatremia (Na <135 mEq/L despite fluid restriction and/or hypertonic saline) treated with Tolvaptan. Patients were divided in two groups according to their glomerular filtration rate [MDRD (mL/min/1,73m2)] at the moment of receiving Tolvaptan (group A <60 and B >60). Na, potassium [K (mEq/L)], creatinine [Cr (mg/dL)] and MDRD, diuresis (mL/h), blood pressure (mmHg) and weight (kg) were evaluated at administration, 24 and 48 hours after.

Results: 35 patients were included (25 in A and 10 in B). Baseline characteristics are shown in table 1. Plasma Na was lower in B (128 ± 4 vs 130 ± 3 in A) with a significant increase in both groups at 24 (134 ± 2 in A vs 134 ± 5 in B) and 48 hours (135 ± 3 in A vs 136 ± 3 in B). Diuresis increased significantly in both groups at 24 hours (273 (95% CI 40-505) in A and 227 (95% CI 120-334) in B) which correlated with a corresponding significant weight loss in group B. We found no changes in K, Cr, MDRD or blood pressure.

Conclusions: In our experience, Tolvaptan was safe and effective in increasing sodium plasma level and diuresis regardless the renal renal function.

Group A

n = 25

Group B

n = 10

Age × ± st

72 ± 13

72 ± 15

Sex female/male n (%)

14 (56) / 11 (44)

4 (40) / 6 (60)

Cardiomyopathy n (%)

Ischemic

7 (28)

4 (40)

Valvular

9 (36)

1 (10)

Ischemic + Valvular

3 (12)

0 (0)

Others

6 (24)

5 (50)

Ejection fraction < 50 n (%)

14 (56)

4 (40)

Treatment n (%)

Furosemide

21 (84)

8 (80)

Aldosterone antagonist

16 (64)

4 (40)

Administered dose 15/30mg n (%)

23 (92) / 2 (8)

9 (90) / 1 (10)



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