Benefit of tolvaptan in the management of hyponatraemia in patients with diuretic-refractory congestive heart failure: the SEMI-SEC project

Fecha de publicación: 01/05/2017

Autores de IIS La Fe

Luis Almenar Bonet

Autor

Participantes ajenos a IIS La Fe

Pose, A
Gavira, JJ
Lopez-Granados, A
Blasco, T
Delgado, J
Aramburu, O
Rodriguez, A
Manzano, L
Manito, N

Grupos

Grupo de Investigación Clínica y Traslacional en Cardiología

Investigador Principal

Esther Roselló Lletí

Abstract

Aims Hyponatraemia is an electrolyte disorder that occurs in advanced congestive heart failure (HF) and worsens prognosis. We explored the usefulness of tolvaptan, which has shown promising results in the treatment of this condition. Methods and results This study is based on a retrospective national registry (2011-15) of patients hospitalized with refractory HF and hyponatraemia who agreed to receive tolvaptan when standard treatment was ineffective. The benefit of tolvaptan was analysed according to the following criteria: normalization ([Na+] >= 135mmol/L) or increased sodium levels [Na+] >= 4mEq/L on completion of treatment, and increase in urine output by 300 or 500mL at 48h. Factors associated with tolvaptan benefit were explored. A total of 241 patients were included, 53.9% of whom had ejection fraction <40%. All patients received concomitant loop diuretics. Initial tolvaptan dose was 17.26.1mg, and end dose was 26.4 +/- 23.2mg (duration 7.8 +/- 8.6days). Serum sodium concentrations increased significantly at 24-48h, from 126.5 +/- 6.2mEq/L at baseline to 134.1 +/- 6.1mEq/L at the end of treatment (P < 0.0001). Weight fell by similar to 5kg before discharge (P < 0.0001) and urine output increased 1.3-fold (P < 0.0001). Normal sodium levels and/or increases of 500mL in urine output were achieved by 90.8% of patients (35.7% achieved both) and 94.8% increased to [Na+] >= 4mEq/L and/or +300mL in urine output (54.4% both). Conclusions An increase in sodium levels and/or improvement in urine output was observed in patients admitted for HF and refractory hyponatraemia under tolvaptan treatment. Tolvaptan may be useful in this setting, in which no effective proven alternatives are available.

Datos de la publicación

ISSN/ISSNe:: 2055-5822, 2055-5822
Tipo:: Article
Páginas:: 130-137
DOI:: 10.1002/ehf2.12124

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Filiaciones

Pose, A:: Complexo Hosp Univ Santiago Compostela, Dept Internal Med, La Coruna, Spain
Almenar, L:: Hosp Univ Politecn La Fe, Cardiol Dept, Valencia, Spain
Gavira, JJ:: Clin Univ Navarra, Cardiol Dept, Pamplona, Spain
Lopez-Granados, A:: Hosp Univ Reina Sofia, Cardiol Dept, Cordoba, Spain
Blasco, T:: Hosp Miguel, Cardiol Dept, Zaragoza, Spain
Delgado, J:: Hosp Univ 12 Octubre, Cardiol Dept, Madrid, Spain
Aramburu, O:: Hosp Univ Virgen La Macarena, Dept Internal Med, Seville, Spain
Rodriguez, A:: Complexo Hosp Univ Vigo, Dept Internal Med, Pontevedra, Spain
Manzano, L:: Hosp Univ Ramon & Cajal, Dept Internal Med, Madrid, Spain

Univ Alcala de Henares, Alcala De Henares, Spain
Manito, N:: Hosp Univ Bellvitge, Cardiol Dept, Barcelona, Spain