Effectiveness Of Tolvaptan On Preventing Renal Dysfunction And Improving Prognosis In Patients With Acute Decompensated Heart Failure

Background: Acute decompensated heart failure(ADHF)is the clinical syndrome of worsening HF symptoms and signs requiring urgent treatment.Over the years,significant progress has been made in the management of chronic HF which resulted in the improved overall life expectancy of the HF population.However,the management of ADHF has not changed much in the last 40 years.Although multiple clinical trials have investigated the role of newer therapies for the treatment of this morbid condition,diuretics and vasodilators continue to remain as the cornerstones of ADHF therapy.Treatment with tolvaptan is considered to have a beneficial effect on ADHF patients.Objective: To evaluate the effectiveness of tolvaptan on preventing renal dysfunction and improving prognosis in patients with ADHF.Methods:175 patients with ADHF were included.Among them,62 were treated with tolvaptan,other patients were treated with routine therapy.The incidence of worsening renal function(WRF),persistent worsening renal function(p-WRF),estimated glomerular filtration rate(eGFR),creatinine and the outcome were observed and compared between the two treatment methods.Results: The incidence of WRF and p-WRF was significantly lower in the tolvaptan therapy group compared with conventional therapy.eGFR decreased and creatinine increased after admission.The decrease of eGFR and increase of creatinine were lower in the tolvaptan group.The dose of furosemide,total hospitalization,In-hospital mortality and survival free of cardiac death or readmission for heart failure during the 90 days after discharge were lower in the TLV compared to the FRM groups.Therapy of tolvaptan also reduced the incidence of WRF and p-WRF and improved prognosis in patients with HF with preserved ejection fraction(HFpEF).Tolvaptan administration for different time significantly affect the incidence of WRF and p-WRF,the decrease of eGFR and increase of creatinine.Administration after 24 h increased the incidence of WRF and pWRF,and aggravated the decrease of eGFR increase of creatinine.The prognosis of patients who received an initial tolvaptan after the first 24 hours was worse compared to patients who received early administration of tolvaptan.Conclusion: Tolvaptan can preserve renal function in patients with HFrEF.It reduce the incidence of WRF and p-WRF,the decrease of eGFR,the increase of creatinine and improve prognosis.Tolvapt therapy is effective in protecting the renal function and improving prognosis of patients with HFpEF.The protective effect of tolvaptan depends on the time of first administration and early administration is recommended.