Sağ Saim, Aydın Kaderli Aysel, Yıldız Abdülmecit, Gül Bülent Cuma, Özdemir Bülent, Baran İbrahim, Güllülü Sümeyye, Aydınlar Ali, Çavuşoğlu Yüksel
Department of Cardiology, Uludağ University Faculty of Medicine, Bursa, Turkey.
Turk Kardiyol Dern Ars. 2017 Jul;45(5):415-425. doi: 10.5543/tkda.2017.80026.
The aim of the present study was to assess the efficacy and safety of tolvaptan for severe hyponatremia (SH) in hypervolemic heart failure (HF) patients within daily clinical practice.
We restrospectively reviewed our database on tolvaptan as an add-on treatment in hypervolemic patients admitted to our clinic due to deterioration of HF and having hyponatremia resistant to standard therapy. Severe hyponatremia was defined as serum sodium concentration ≤125 mEq/L. The database included demographic, clinical, laboratory, and echocardiographic findings on admission, and numerous outcome measures for oral tolvaptan treatment were used to assess its efficacy and safety.
The study group consisted of 56 hypervolemic HF patients with severe hyponatremia (25 female and 31 male) with mean age of 66 years. All patients received a single dose of tolvaptan 15 mg daily for an average of 3.2 days due to severe hyponatremia. Sodium and potassium concentrations, fluid intake, and urine volume increased (p<0.0001, p=0.037, p<0.0001, and p<0.0001, respectively), whereas furosemide dosage, body weight, heart rate, systolic and diastolic blood pressure, and New York Heart Association class decreased significantly in response to tolvaptan treatment, without a rise in serum creatinine or urea concentrations (p<0.0001, p<0.0001, p=0.001, p<0.049, p<0.009 ve p=0.001, respectively).
In this retrospective, single-centered study conducted in a small group of Turkish patients, short-term treatment with low-dose tolvaptan added to standard therapy of hypervolemic HF patients with severe hyponatremia was well tolerated with a low rate of major side effects and was effective in correcting severe hyponatremia.
本研究旨在评估在日常临床实践中，托伐普坦治疗高血容量性心力衰竭（HF）患者严重低钠血症（SH）的疗效和安全性。
我们回顾性分析了我们的数据库，该数据库涉及因HF恶化且对标准治疗耐药的低钠血症而入住我们诊所的高血容量患者使用托伐普坦作为附加治疗的情况。严重低钠血症定义为血清钠浓度≤125 mEq/L。该数据库包括入院时的人口统计学、临床、实验室和超声心动图检查结果，并使用了多种口服托伐普坦治疗的结局指标来评估其疗效和安全性。
研究组由56例严重低钠血症的高血容量HF患者组成（25例女性和31例男性），平均年龄66岁。由于严重低钠血症，所有患者均接受每日15 mg托伐普坦单剂量治疗，平均治疗3.2天。钠和钾浓度、液体摄入量和尿量增加（分别为p<0.0001、p=0.037、p<0.0001和p<0.0001），而托伐普坦治疗后，呋塞米剂量、体重、心率、收缩压和舒张压以及纽约心脏协会分级显著降低，血清肌酐或尿素浓度未升高（分别为p<0.0001、p<0.0001、p=0.001、p<0.049、p<0.009和p=0.001）。
在这项对一小群土耳其患者进行的回顾性单中心研究中，在高血容量HF伴严重低钠血症患者的标准治疗中添加低剂量托伐普坦进行短期治疗，耐受性良好，主要副作用发生率低，且能有效纠正严重低钠血症。
