Efficacy and safety of tolvaptan in chronic heart failure

Background The efficacy and safety of tolvaptan (TLV) in patients with chronic heart failure (CHF) are unclear. Aim The aim of this study was to evaluate the efficacy and safety of tolvaptan (TLV) versus conventional therapy, primarily furosemide (FRM). In addition, the effect of the nutritional status on the efficacy of TLV was evaluated. Method This retrospective study included patients with CHF who were hospitalised and treated between March 2015 and February 2019, including 51 patients in the FRM group and 63 patients in the TLV group. Result Weight loss did not differ between the FRM and TLV groups (-2.1 +/- 2.1 kg vs -1.5 +/- 3.5 kg, p = 0.250). After 7 days, the change in the estimated glomerular filtration rate was significantly smaller in the FRM group (56.5 +/- 22.2 vs 51.9 +/- 20.0 mL/min/1.73 m(2), p = 0.002). There was no significant difference in serum sodium (Na) levels between days 0 and 7 in the FRM group (138.8 +/- 5.2 vs 139.2 +/- 3.9 mEq/L, p = 0.487). However, the serum Na level was significantly increased in the TLV group (138.4 +/- 5.0 mEq/L vs 139.4 +/- 4.0 mEq/L, p = 0.047). There was no significant correlation between weight loss due to diuresis and the objective prognostic nutritional index in either group. Conclusion In hyponatremic patients with CHF, TLV may be more effective than FRM in slowing the course of renal damage and elevating serum Na levels; however, nutritional indices may not be necessary to consider while administering TLV.