Takagi Koji, Sato Naoki, Ishihara Shiro, Sone Michiko, Tokuyama Hideo, Nakama Kenji, Omote Toshiya, Kikuchi Arifumi, Ishikawa Masahiro, Amitani Kenichi, Takahashi Naoto, Maruyama Yuji, Imura Hajime, Shimizu Wataru
Cardiology and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Musashi-Kosugi, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan.
Department of Cardiovascular Surgery, Nippon Medical School Musashi-Kosugi Hospital, Musashi-Kosugi, Kawasaki, Japan.
Heart Vessels. 2018 Apr;33(4):413-420. doi: 10.1007/s00380-017-1066-4. Epub 2017 Oct 23.
Hypoalbuminemia is an independent prognostic factor in hospitalization for heart failure (HHF). Hypoalbuminemia or proteinuria is related to resistance to loop diuretics. Tolvaptan is an oral non-peptide, competitive antagonist of vasopressin receptor-2. It has been used for the treatment of volume overload in HHF patients in several Asian countries. Several studies have demonstrated marked improvement in congestion in HHF patients. However, whether tolvaptan is useful for HHF patients with hypoalbuminemia or proteinuria (both of which are related to resistance to loop diuretics) has not been clarified. We examined the diuretic response to tolvaptan in HHF patients with hypoalbuminemia or proteinuria. We defined hypoalbuminemia as a serum level of albumin < 2.6 g/dl. Fifty-one HHF patients who received additional tolvaptan upon therapies with loop diuretics were divided into the hypoalbuminemia group (n = 24) or control group (n = 27). The changes in urine output per day were not different between the two groups [610 (range 100-1032); 742 (505-1247) ml, P = 0.313]. There was no difference in diuretic responses between patients with and without proteinuria. The serum level of albumin did not correlate with changes in urine output per day after tolvaptan treatment (P = 0.276, r = 0.156). Thus, additional administration of tolvaptan elicited a good diuretic response in HHF patients with hypoalbuminemia or proteinuria. These data suggest that tolvaptan might be beneficial for such HHF patients.
低白蛋白血症是心力衰竭住院（HHF）的一个独立预后因素。低白蛋白血症或蛋白尿与袢利尿剂抵抗有关。托伐普坦是一种口服非肽类血管加压素2型受体竞争性拮抗剂。在几个亚洲国家，它已被用于治疗HHF患者的容量超负荷。多项研究表明HHF患者的充血情况有显著改善。然而，托伐普坦对伴有低白蛋白血症或蛋白尿（这两者均与袢利尿剂抵抗有关）的HHF患者是否有用尚未明确。我们研究了托伐普坦对伴有低白蛋白血症或蛋白尿的HHF患者的利尿反应。我们将低白蛋白血症定义为血清白蛋白水平<2.6 g/dl。51例在接受袢利尿剂治疗的基础上额外接受托伐普坦治疗的HHF患者被分为低白蛋白血症组（n = 24）或对照组（n = 27）。两组每日尿量变化无差异[610（范围100 - 1032）；742（505 - 1247）ml，P = 0.313]。有蛋白尿和无蛋白尿的患者之间利尿反应无差异。托伐普坦治疗后，血清白蛋白水平与每日尿量变化无相关性（P = 0.276，r = 0.156）。因此，额外给予托伐普坦对伴有低白蛋白血症或蛋白尿的HHF患者产生了良好的利尿反应。这些数据表明托伐普坦可能对这类HHF患者有益。
