Kawabata Hiroaki, Iwatani Hirotsugu, Yamamichi Yuko, Shirahase Keiko, Nagai Naoko, Isaka Yoshitaka
Department of Nephrology, Higashiosaka City Medical Center, Japan.
Department of Nephrology, National Hospital Organization, Osaka National Hospital, Japan.
Intern Med. 2019 Mar 1;58(5):639-642. doi: 10.2169/internalmedicine.0993-18. Epub 2018 Nov 19.
Objective Tolvaptan is a class of diuretics that reduce body water through aquaresis. One of the most prominent characteristics of these agents is that worsening of the renal function is less likely to occur. We investigated the underlying mechanism concerning the change in the intracellular fluid (ICF) when the body fluid is reduced. Methods In this retrospective observational study, five overhydrated chronic kidney disease (CKD) patients with edema or pleural effusion treated with tolvaptan were assessed by the bioelectrical impedance method twice: once before and once after tolvaptan therapy. The changes in the ICF rate were compared with those in 11 hemodialysis patients undergoing body fluid reduction by hemodialysis. Results Removal of the body fluid either by tolvaptan or by hemodialysis increased the post/pre-ratio of ICW/total body water (TBW). Tolvaptan reduced the ICF more efficiently than hemodialysis. Conclusion Tolvaptan treatment lessens body fluid by the efficient reduction of the ICF.
目的 托伐普坦是一类通过排水作用减少机体水分的利尿剂。这些药物最显著的特点之一是肾功能恶化的可能性较小。我们研究了体液减少时细胞内液（ICF）变化的潜在机制。方法 在这项回顾性观察研究中，对5例接受托伐普坦治疗的伴有水肿或胸腔积液的慢性肾脏病（CKD）水过多患者，采用生物电阻抗法进行了两次评估：一次在托伐普坦治疗前，一次在治疗后。将ICF率的变化与11例通过血液透析进行体液减少的血液透析患者的变化进行了比较。结果 托伐普坦或血液透析去除体液均增加了细胞内液（ICW）与总体水（TBW）的治疗后/治疗前比值。托伐普坦比血液透析更有效地减少了ICF。结论 托伐普坦治疗通过有效减少ICF减轻了体液。
