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

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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 languageEnglish (US)
Pages (from-to)802-812
Number of pages11
JournalClinical Research in Cardiology
Issue number10
StatePublished - Oct 1 2017


  • Acute heart failure
  • Diuretics
  • Dyspnea relief
  • Worsening renal function

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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