Early treatment with tolvaptan improves diuretic response in acute heart failure with renal dysfunction

Yuya Matsue; Jozine M. Ter Maaten; Makoto Suzuki; Sho Torii; Satoshi Yamaguchi; Seiji Fukamizu; Yuichi Ono; Hiroyuki Fujii; Takeshi Kitai; Toshihiko Nishioka; Kaoru Sugi; Yuko Onishi; Makoto Noda; Nobuyuki Kagiyama; Yasuhiro Satoh; Kazuki Yoshida; Peter van der Meer; Kevin Damman; Adriaan A. Voors; Steven R. Goldsmith

doi:10.1007/s00392-017-1122-1

Early treatment with tolvaptan improves diuretic response in acute heart failure with renal dysfunction

Yuya Matsue, Jozine M. Ter Maaten, Makoto Suzuki, Sho Torii, Satoshi Yamaguchi, Seiji Fukamizu, Yuichi Ono, Hiroyuki Fujii, Takeshi Kitai, Toshihiko Nishioka, Kaoru Sugi, Yuko Onishi, Makoto Noda, Nobuyuki Kagiyama, Yasuhiro Satoh, Kazuki Yoshida, Peter van der Meer, Kevin Damman, Adriaan A. Voors, Steven R. Goldsmith

Medicine - Cardiology Division

Research output: Contribution to journal › Article › peer-review

29 Scopus citations

Abstract

Background: Poor response to diuretics is associated with worse prognosis in patients with acute heart failure (AHF). We hypothesized that treatment with tolvaptan improves diuretic response in patients with AHF. Methods: We performed a secondary analysis of the AQUAMARINE open-label randomized study in which a total of 217 AHF patients with renal impairment (eGFR < 60 mL/min/1.73 m²) were randomized to either tolvaptan or conventional treatment. We evaluated diuretic response to 40 mg furosemide or its equivalent based on two different parameters: change in body weight and net fluid loss within 48 h. Results: The mean time from patient presentation to randomization was 2.9 h. Patients with a better diuretic response showed greater relief of dyspnea and less worsening of renal function. Tolvaptan patients showed a significantly better diuretic response measured by diuretic response based both body weight [−1.16 (IQR −3.00 to −0.57) kg/40 mg vs. −0.51 (IQR −1.13 to −0.20) kg/40 mg; P < 0.001] and net fluid loss [2125.0 (IQR 1370.0–3856.3) mL/40 mg vs. 1296.3 (IQR 725.2–1726.5) mL/40 mg; P < 0.001]. Higher diastolic blood pressure and use of tolvaptan were independent predictors of a better diuretic response. Conclusions: Better diuretic response was associated with greater dyspnea relief and less WRF. Early treatment with tolvaptan significantly improved diuretic response in AHF patients with renal dysfunction.

Original language	English (US)
Pages (from-to)	802-812
Number of pages	11
Journal	Clinical Research in Cardiology
Volume	106
Issue number	10
DOIs	https://doi.org/10.1007/s00392-017-1122-1
State	Published - Oct 1 2017

Bibliographical note

Funding Information:
AQUAMARINE study was funded by Japan Heart Foundation Multicenter Study Grant. Dr.Yuya Matsue is supported by JSPS (Japan Society for the Promortion of Science) Overseas Research Fellowship, and received a honorarium from Otsuka Pharmaceutical Co. Dr. Makoto Suzuki received lectures honoraria from Bayer, Otsuka Pharmaceutical Co., Biotronik Japan Co., Daiichi-Snakyo, Medtronic Japan Co., Ltd., St. Jude Medical Japan, and Fukuda Denshi. Dr. Yuichi ono received lectures honoraria from Medtronic Japan Co., Ltd. Dr. Kazuki Yoshida receives tuition support jointly from the Japan Student Services Organization and Harvard T. H. Chan School of Public Health (partially supported by training Grants from Pfizer, Takeda, Bayer, and PhRMA). Dr. Kaoru Sugi received scholarship fund from Daiichi-Sankyo Pharmaceutical and lectures honoraria from Bayer. Dr. Steven R. Goldsmith received consulting fees, speaking fees, and research support from Otsuka USA and Otsuka-Japan. The other authors have nothing to disclose related to this paper.

Funding Information:
Funding AQUAMARINE study was funded by Japan Heart Foundation Multicenter Study Grant.

Publisher Copyright:
© 2017, The Author(s).

Keywords

Acute heart failure
Diuretics
Dyspnea relief
Worsening renal function

Publisher link

10.1007/s00392-017-1122-1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613036

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Matsue, Y., Ter Maaten, J. M., Suzuki, M., Torii, S., Yamaguchi, S., Fukamizu, S., Ono, Y., Fujii, H., Kitai, T., Nishioka, T., Sugi, K., Onishi, Y., Noda, M., Kagiyama, N., Satoh, Y., Yoshida, K., van der Meer, P., Damman, K., Voors, A. A., & Goldsmith, S. R. (2017). Early treatment with tolvaptan improves diuretic response in acute heart failure with renal dysfunction. Clinical Research in Cardiology, 106(10), 802-812. https://doi.org/10.1007/s00392-017-1122-1

Matsue, Y, Ter Maaten, JM, Suzuki, M, Torii, S, Yamaguchi, S, Fukamizu, S, Ono, Y, Fujii, H, Kitai, T, Nishioka, T, Sugi, K, Onishi, Y, Noda, M, Kagiyama, N, Satoh, Y, Yoshida, K, van der Meer, P, Damman, K, Voors, AA & Goldsmith, SR 2017, 'Early treatment with tolvaptan improves diuretic response in acute heart failure with renal dysfunction', Clinical Research in Cardiology, vol. 106, no. 10, pp. 802-812. https://doi.org/10.1007/s00392-017-1122-1

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title = "Early treatment with tolvaptan improves diuretic response in acute heart failure with renal dysfunction",

abstract = "Background: Poor response to diuretics is associated with worse prognosis in patients with acute heart failure (AHF). We hypothesized that treatment with tolvaptan improves diuretic response in patients with AHF. Methods: We performed a secondary analysis of the AQUAMARINE open-label randomized study in which a total of 217 AHF patients with renal impairment (eGFR < 60 mL/min/1.73 m2) were randomized to either tolvaptan or conventional treatment. We evaluated diuretic response to 40 mg furosemide or its equivalent based on two different parameters: change in body weight and net fluid loss within 48 h. Results: The mean time from patient presentation to randomization was 2.9 h. Patients with a better diuretic response showed greater relief of dyspnea and less worsening of renal function. Tolvaptan patients showed a significantly better diuretic response measured by diuretic response based both body weight [−1.16 (IQR −3.00 to −0.57) kg/40 mg vs. −0.51 (IQR −1.13 to −0.20) kg/40 mg; P < 0.001] and net fluid loss [2125.0 (IQR 1370.0–3856.3) mL/40 mg vs. 1296.3 (IQR 725.2–1726.5) mL/40 mg; P < 0.001]. Higher diastolic blood pressure and use of tolvaptan were independent predictors of a better diuretic response. Conclusions: Better diuretic response was associated with greater dyspnea relief and less WRF. Early treatment with tolvaptan significantly improved diuretic response in AHF patients with renal dysfunction.",

keywords = "Acute heart failure, Diuretics, Dyspnea relief, Worsening renal function",

author = "Yuya Matsue and {Ter Maaten}, {Jozine M.} and Makoto Suzuki and Sho Torii and Satoshi Yamaguchi and Seiji Fukamizu and Yuichi Ono and Hiroyuki Fujii and Takeshi Kitai and Toshihiko Nishioka and Kaoru Sugi and Yuko Onishi and Makoto Noda and Nobuyuki Kagiyama and Yasuhiro Satoh and Kazuki Yoshida and {van der Meer}, Peter and Kevin Damman and Voors, {Adriaan A.} and Goldsmith, {Steven R.}",

note = "Funding Information: AQUAMARINE study was funded by Japan Heart Foundation Multicenter Study Grant. Dr.Yuya Matsue is supported by JSPS (Japan Society for the Promortion of Science) Overseas Research Fellowship, and received a honorarium from Otsuka Pharmaceutical Co. Dr. Makoto Suzuki received lectures honoraria from Bayer, Otsuka Pharmaceutical Co., Biotronik Japan Co., Daiichi-Snakyo, Medtronic Japan Co., Ltd., St. Jude Medical Japan, and Fukuda Denshi. Dr. Yuichi ono received lectures honoraria from Medtronic Japan Co., Ltd. Dr. Kazuki Yoshida receives tuition support jointly from the Japan Student Services Organization and Harvard T. H. Chan School of Public Health (partially supported by training Grants from Pfizer, Takeda, Bayer, and PhRMA). Dr. Kaoru Sugi received scholarship fund from Daiichi-Sankyo Pharmaceutical and lectures honoraria from Bayer. Dr. Steven R. Goldsmith received consulting fees, speaking fees, and research support from Otsuka USA and Otsuka-Japan. The other authors have nothing to disclose related to this paper. Funding Information: Funding AQUAMARINE study was funded by Japan Heart Foundation Multicenter Study Grant. Publisher Copyright: {\textcopyright} 2017, The Author(s).",

year = "2017",

month = oct,

day = "1",

doi = "10.1007/s00392-017-1122-1",

language = "English (US)",

volume = "106",

pages = "802--812",

journal = "Clinical Research in Cardiology",

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TY - JOUR

T1 - Early treatment with tolvaptan improves diuretic response in acute heart failure with renal dysfunction

AU - Matsue, Yuya

AU - Ter Maaten, Jozine M.

AU - Suzuki, Makoto

AU - Torii, Sho

AU - Yamaguchi, Satoshi

AU - Fukamizu, Seiji

AU - Ono, Yuichi

AU - Fujii, Hiroyuki

AU - Kitai, Takeshi

AU - Nishioka, Toshihiko

AU - Sugi, Kaoru

AU - Onishi, Yuko

AU - Noda, Makoto

AU - Kagiyama, Nobuyuki

AU - Satoh, Yasuhiro

AU - Yoshida, Kazuki

AU - van der Meer, Peter

AU - Damman, Kevin

AU - Voors, Adriaan A.

AU - Goldsmith, Steven R.

N1 - Funding Information: AQUAMARINE study was funded by Japan Heart Foundation Multicenter Study Grant. Dr.Yuya Matsue is supported by JSPS (Japan Society for the Promortion of Science) Overseas Research Fellowship, and received a honorarium from Otsuka Pharmaceutical Co. Dr. Makoto Suzuki received lectures honoraria from Bayer, Otsuka Pharmaceutical Co., Biotronik Japan Co., Daiichi-Snakyo, Medtronic Japan Co., Ltd., St. Jude Medical Japan, and Fukuda Denshi. Dr. Yuichi ono received lectures honoraria from Medtronic Japan Co., Ltd. Dr. Kazuki Yoshida receives tuition support jointly from the Japan Student Services Organization and Harvard T. H. Chan School of Public Health (partially supported by training Grants from Pfizer, Takeda, Bayer, and PhRMA). Dr. Kaoru Sugi received scholarship fund from Daiichi-Sankyo Pharmaceutical and lectures honoraria from Bayer. Dr. Steven R. Goldsmith received consulting fees, speaking fees, and research support from Otsuka USA and Otsuka-Japan. The other authors have nothing to disclose related to this paper. Funding Information: Funding AQUAMARINE study was funded by Japan Heart Foundation Multicenter Study Grant. Publisher Copyright: © 2017, The Author(s).

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background: Poor response to diuretics is associated with worse prognosis in patients with acute heart failure (AHF). We hypothesized that treatment with tolvaptan improves diuretic response in patients with AHF. Methods: We performed a secondary analysis of the AQUAMARINE open-label randomized study in which a total of 217 AHF patients with renal impairment (eGFR < 60 mL/min/1.73 m2) were randomized to either tolvaptan or conventional treatment. We evaluated diuretic response to 40 mg furosemide or its equivalent based on two different parameters: change in body weight and net fluid loss within 48 h. Results: The mean time from patient presentation to randomization was 2.9 h. Patients with a better diuretic response showed greater relief of dyspnea and less worsening of renal function. Tolvaptan patients showed a significantly better diuretic response measured by diuretic response based both body weight [−1.16 (IQR −3.00 to −0.57) kg/40 mg vs. −0.51 (IQR −1.13 to −0.20) kg/40 mg; P < 0.001] and net fluid loss [2125.0 (IQR 1370.0–3856.3) mL/40 mg vs. 1296.3 (IQR 725.2–1726.5) mL/40 mg; P < 0.001]. Higher diastolic blood pressure and use of tolvaptan were independent predictors of a better diuretic response. Conclusions: Better diuretic response was associated with greater dyspnea relief and less WRF. Early treatment with tolvaptan significantly improved diuretic response in AHF patients with renal dysfunction.

AB - Background: Poor response to diuretics is associated with worse prognosis in patients with acute heart failure (AHF). We hypothesized that treatment with tolvaptan improves diuretic response in patients with AHF. Methods: We performed a secondary analysis of the AQUAMARINE open-label randomized study in which a total of 217 AHF patients with renal impairment (eGFR < 60 mL/min/1.73 m2) were randomized to either tolvaptan or conventional treatment. We evaluated diuretic response to 40 mg furosemide or its equivalent based on two different parameters: change in body weight and net fluid loss within 48 h. Results: The mean time from patient presentation to randomization was 2.9 h. Patients with a better diuretic response showed greater relief of dyspnea and less worsening of renal function. Tolvaptan patients showed a significantly better diuretic response measured by diuretic response based both body weight [−1.16 (IQR −3.00 to −0.57) kg/40 mg vs. −0.51 (IQR −1.13 to −0.20) kg/40 mg; P < 0.001] and net fluid loss [2125.0 (IQR 1370.0–3856.3) mL/40 mg vs. 1296.3 (IQR 725.2–1726.5) mL/40 mg; P < 0.001]. Higher diastolic blood pressure and use of tolvaptan were independent predictors of a better diuretic response. Conclusions: Better diuretic response was associated with greater dyspnea relief and less WRF. Early treatment with tolvaptan significantly improved diuretic response in AHF patients with renal dysfunction.

KW - Acute heart failure

KW - Diuretics

KW - Dyspnea relief

KW - Worsening renal function

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Early treatment with tolvaptan improves diuretic response in acute heart failure with renal dysfunction

Abstract

Bibliographical note

Keywords

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