Background: Tolvaptan, a selective V2 receptor antagonist, can increase net volume loss in acute decompensated heart failure (ADHF) with compromised renal function. We aimed to elucidate clinical factors associated with worsening renal function (WRF) in tolvaptan-treated ADHF patients. Methods: We enrolled 47 consecutive ADHF patients (M/F 29/18, age 77.4 years) who treated with tolvaptan in addition to standard therapy. We examined the differences in clinical factors between patients with and without WRF (serum creatinine > 0.3 mg/dL). We also clarified the associated factors for the maximum increment of serum creatinine during hospitalization. Results: Hematocrit (P = .007) and serum albumin (P = .019) were significantly lower, and serum osmolarity (P = .031) was significantly higher in patients showing WRF (n = 7). No differences were observed in age, medications, urine volume and osmolarity, renal function and the tolvaptan doses. In multivariate regression analysis, the maximum increment of serum creatinine during 96-hour hospitalization was independently associated with serum osmolarity at admission (P = .016) among the significant factors such as serum osmolarity at admission, the amount of changes in serum Na and total urine volume in univariate analysis. Conclusions: In tolvaptan treatment combined with standard therapy of ADHF patients, high serum osmolarity may be a determinant factor for WRF during their hospitalization. Further examinations regarding the affecting factors for high serum osmolarity and its relation to WRF are needed.
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