Tolvaptan for Heart Failure with Volume Overload not Responding to Conventional Treatment: A Retrospective Analysis

INTRODUCTION: To study outcomes in patients with heart failure (HF) resistant to conventional diuretic therapy receiving add-on tolvaptan (vasopressin 2 receptor antagonist) or ultrafiltration.
METHODS: In this study, a retrospective analysis was performed on the patients with HF who had significant volume overload, ischemic dilated cardiomyopathy, and hyponatremia (serum sodium: 125-135 mEq/L) resistant to conventional treatment who received add-on oral tolvaptan 15 mg/day or ultrafiltration.
RESULTS: Outcomes included a change from baseline in serum sodium, blood urea nitrogen (BUN), serum creatinine and body weight after three days. Changes in baseline hepatic enzymes and fasting blood glucose were analyzed in the tolvaptan arm 24 hours after stopping treatment. The analysis included 26 patients (tolvaptan: n=13; ultrafiltration: n=13). The overall baseline median (min, max) values were as follows: serum sodium 131 (122, 140) mEq/L, BUN 60.5 (21, 120) mg/dL, serum creatinine 1.6 (0.8, 3.7) mg/dL, body weight 76 (51, 92) kg. After three days, baseline serum sodium increased significantly in both arms with a significantly greater median % change in the tolvaptan arm (5 [-7, 12]) versus ultrafiltration (1 [-1, 8], p=0.037). No significant change in baseline BUN in the tolvaptan arm while it decreased in ultrafiltration arm (p=0.001). In both arms, there was significant weight loss and no significant change in serum creatinine versus baseline. No significant change was observed in baseline fasting glucose or hepatic enzyme levels in the tolvaptan arm. There were not any serious adverse events.

DISCUSSION AND CONCLUSION: The outcomes of patients with HF whose volume overload resistant to conventional treatment receiving add-on tolvaptan or ultrafiltration were not different concerning improving hyponatremia and inducing weight loss, without worsening of renal function.