The potential effectiveness of tolvaptan in critically ill patients including cardiac and noncardiac populations: a retrospective observational study.

We investigated the potential diuretic effectiveness of the selective arginine vasopressin 2 receptor antagonist tolvaptan in critically ill patients including cardiac and noncardiac populations. This was a single-center retrospective observational study. We analyzed the data of our hospital's critically ill adult patients (n = 473) including noncardiac as well as cardiac populations who had an ICU stay ≥ 4 days in 2019-2020 and who did not undergo renal transplantation or permanent renal replacement therapy before their ICU admission. Adjusting for several confounders (the patients' disease severity, comorbidities including cardiac disease, and diuretics used), we estimated the predictors for the patients whose daily urine volume had increased by up to twofold or more compared to the minimal value (the primary endpoint) by applying a multivariable logistic regression model. We also investigated tolvaptan's effect on time-course changes in the serum creatine (sCr) level (the secondary endpoint) by using a generalized estimating equation model. Tolvaptan use was significantly correlated with increased urine volume (odds ratio [OR] 1.86, 95%CI 1.13-3.06, p = 0.015) but was not significantly associated with time-course changes in the sCr level: beta estimator [95%CI], 0.07 [- 0.01 to 0.15], p = 0.08. Tolvaptan independently increased the urine volume, apparently without worsening the renal function in critically ill patients including cardiac and noncardiac populations.