Nishino Masami, Egami Yasuyuki, Tanaka Akihiro, Kawanami Shodai, Sugae Hiroki, Ukita Kohei, Kawamura Akito, Nakamura Hitoshi, Matsuhiro Yutaka, Yasumoto Koji, Tsuda Masaki, Okamoto Naotaka, Matsunaga-Lee Yasuharu, Yano Masamichi, Tanouchi Jun
Division of Cardiology, Osaka Rosai Hospital, Sakai 591-8025, Japan.
J Clin Med. 2022 Feb 13;11(4):977. doi: 10.3390/jcm11040977.
(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.
(1) 背景：据报道，托伐普坦（TLV）对急性失代偿性心力衰竭（ADHF）患者具有肾脏保护作用，但这种作用是否能长期持续尚不清楚。因此，我们评估了TLV在ADHF患者中的肾脏保护作用的时间进程以及预后情况。(2) 方法：我们调查了来自大阪罗赛医院急性心力衰竭登记处（AURORA）登记系统的911例ADHF患者。经过倾向评分匹配后，对58例住院至少两天后开始接受TLV治疗的患者（TLV组）和58例未接受TLV治疗的患者（非TLV组）进行了检查。我们比较了基线与各时间点（五天、出院时和一年）之间肌酐（Cr）和估算肾小球滤过率（eGFR）的变化，以此作为肾脏保护作用的指标，并比较了两组之间一年的再住院率和全因死亡率。(3) 结果：入院五天后，TLV组的Cr和eGFR水平变化显著高于非TLV组，但两组之间的差异逐渐减小。Kaplan-Meier分析表明，TLV组和非TLV组的生存率和再住院率在一年之内相似。(4) TLV的肾脏保护作用呈现出时间变化，这可能与TLV无长期有益作用相关。
