Temporal Change in Renoprotective Effect of Tolvaptan on Patients with Heart Failure: AURORA Study.

(1) Background: It has been reported that tolvaptan (TLV) has a renoprotective effect in acute decompensated heart failure (ADHF) patients, but whether this effect is continued for a long time is unclear. Thus, we evaluated the time course of the renoprotective effect of TLV, in addition to the prognosis, in ADHF patients. (2) Methods: We investigated 911 ADHF patients from the AURORA (Acute Heart Failure Registry in Osaka Rosai Hospital) registry. After propensity score matching, 58 patients who started to receive TLV at least two days after the hospitalization (TLV group) and 58 who did not (non-TLV group) were examined. We compared the changes in the creatinine (Cr) and estimated glomerular filtration rate (eGFR) between baseline and each time point (five days, discharge, and one year) as the index of the renoprotective effect, and rate of rehospitalizations and all-cause mortality for one year between the two groups. (3) Results: The change in Cr and eGFR levels was significantly higher in the TLV group than the non-TLV group five days after admission but the difference between the two groups gradually diminished. A Kaplan-Meier analysis showed that the survival and rehospitalization rates in the TLV and non-TLV groups were similar up to one year. (4) TLV revealed a temporal change in the renoprotective effect, which may be correlated with no long-term beneficial effect of TLV.