Okayama Dai, Suzuki Tsuyoshi, Shiga Tsuyoshi, Minami Yuichiro, Tsuruoka Shuichi, Hagiwara Nobuhisa
Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Am J Cardiovasc Drugs. 2015 Aug;15(4):289-93. doi: 10.1007/s40256-015-0121-8.
Arginine vasopressin-stimulated reabsorption of urea occurs in the collecting duct via increased expression of the urea transporter.
The aim of this study was to evaluate whether the blood urea nitrogen/creatinine (BUN/Cr) ratio is useful for predicting tolvaptan response in patients with decompensated heart failure (HF).
Among 71 consecutive patients with HF who received oral tolvaptan between 2010 and 2014, we retrospectively studied 33 patients with decompensated HF without any mechanical circulatory assistance or inotropic support who had already been treated with loop diuretics. A responder to tolvaptan was defined as an individual who experienced a ≥30 % increase in their respective 24-h urine volume.
Among the 33 patients, 21 met the criteria of a responder. The area under the receiver operating characteristic curves of BUN/Cr and BUN were 0.790 and 0.714, respectively, and the respective cut-off values for responders to tolvaptan were 23.8 and 49.0. BUN/Cr and BUN retained their significant relationships with the responder status (odds ratio for BUN/Cr >23.8: 20.9; 95 % confidence interval [CI] 2.7-531.1; p = 0.002; odds ratio for BUN ≥49: 7.7; 95 % CI 1.4-65.8; p = 0.02).
Our results suggest that high BUN/Cr may be a predictor of response to tolvaptan in decompensated HF patients. A prospective study with a large sample size is required to confirm this preliminary finding.
精氨酸加压素刺激的尿素重吸收通过尿素转运体表达增加在集合管中发生。
本研究旨在评估血尿素氮/肌酐（BUN/Cr）比值是否有助于预测失代偿性心力衰竭（HF）患者对托伐普坦的反应。
在2010年至2014年期间接受口服托伐普坦的71例连续性HF患者中，我们回顾性研究了33例未接受任何机械循环辅助或正性肌力支持、已接受襻利尿剂治疗的失代偿性HF患者。托伐普坦反应者定义为24小时尿量各自增加≥30%的个体。
33例患者中，21例符合反应者标准。BUN/Cr和BUN的受试者工作特征曲线下面积分别为0.790和0.714，托伐普坦反应者的各自截断值为23.8和49.0。BUN/Cr和BUN与反应者状态保持显著关系（BUN/Cr>23.8的优势比：20.9；95%置信区间[CI]2.7 - 531.1；p = 0.002；BUN≥49的优势比：7.7；95%CI 1.4 - 65.8；p = 0.02）。
我们的结果表明，高BUN/Cr可能是失代偿性HF患者对托伐普坦反应的预测指标。需要进行大样本量的前瞻性研究来证实这一初步发现。
