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2017 ; 4
(2
): 130-137
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Benefit of tolvaptan in the management of hyponatraemia in patients with
diuretic-refractory congestive heart failure: the SEMI-SEC project
#MMPMID28451449
Pose A
; Almenar L
; Gavira JJ
; López-Granados A
; Blasco T
; Delgado J
; Aramburu O
; Rodríguez A
; Manzano L
; Manito N
ESC Heart Fail
2017[May]; 4
(2
): 130-137
PMID28451449
show ga
AIMS: Hyponatraemia is an electrolyte disorder that occurs in advanced congestive
heart failure (HF) and worsens prognosis. We explored the usefulness of
tolvaptan, which has shown promising results in the treatment of this condition.
METHODS AND RESULTS: This study is based on a retrospective national registry
(2011-15) of patients hospitalized with refractory HF and hyponatraemia who
agreed to receive tolvaptan when standard treatment was ineffective. The benefit
of tolvaptan was analysed according to the following criteria: normalization
([Na(+)] ? 135 mmol/L) or increased sodium levels [Na(+)] ? 4 mEq/L on completion
of treatment, and increase in urine output by 300 or 500 mL at 48 h. Factors
associated with tolvaptan benefit were explored. A total of 241 patients were
included, 53.9% of whom had ejection fraction <40%. All patients received
concomitant loop diuretics. Initial tolvaptan dose was 17.2 ± 6.1 mg, and end
dose was 26.4 ± 23.2 mg (duration 7.8 ± 8.6 days). Serum sodium concentrations
increased significantly at 24-48 h, from 126.5 ± 6.2 mEq/L at baseline to
134.1 ± 6.1 mEq/L at the end of treatment (P < 0.0001). Weight fell by ~5 kg
before discharge (P < 0.0001) and urine output increased 1.3-fold (P < 0.0001).
Normal sodium levels and/or increases of 500 mL in urine output were achieved by
90.8% of patients (35.7% achieved both) and 94.8% increased to [Na(+)] ? 4 mEq/L
and/or +300 mL in urine output (54.4% both). CONCLUSIONS: An increase in sodium
levels and/or improvement in urine output was observed in patients admitted for
HF and refractory hyponatraemia under tolvaptan treatment. Tolvaptan may be
useful in this setting, in which no effective proven alternatives are available.