Background: Tolvaptan has been reported to be effective for treating acute decompensated heart
failure and chronic heart failure. Whether it is also effective for treating chronic
heart failure, however, remains unclear. We therefore aimed to assess the efficacy
of tolvaptan in patients with chronic heart failure and chronic kidney disease. Methods: We examined the change of such parameters as estimated glomerular filtration rates,
BNP levels, serum sodium concentration levels, and loop diuretic doses before and
six months after the initiation of tolvaptan therapy in nine patients with chronic
heart failure and chronic kidney disease. Prior to the initiation of tolvaptan therapy,
all the nine patients were hyponatremic and hypotensive, with New York Heart Association
class II or III heart failure, receiving a dose of more than or equal 60 mg furosemide
per day. Results: The loop diuretic doses and BNP levels six months after the initiation of tolvaptan
therapy were both significantly lower than those before the initiation of tolvaptan
therapy (27.8 ± 4.4 mg vs 81.1 ± 41.1 mg, P = .002 and 779 ± 1218 pg/mL vs 1104 ± 1305 pg/mL, P = .0298, respectively). Conclusion: Tolvaptan therapy may contribute to reduce the loop diuretic doses and lower BNP
levels in patients with chronic kidney disease and chronic heart failure.
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