Yamazaki Yuma, Niwa Hidetomo, Ishiyama Erina, Hori Mirei, Sugo Yuki, Hirota Kazuyoshi
Department of Anesthesiology, Hirosaki University Hospital, 53 Honcho, Hirosaki, Aomori, 036-8563, Japan.
Department of Community Medicine for Perioperative Management, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, Aomori, 036-8562, Japan.
Naunyn Schmiedebergs Arch Pharmacol. 2025 May;398(5):5427-5436. doi: 10.1007/s00210-024-03618-2. Epub 2024 Nov 18.
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.
我们研究了选择性精氨酸加压素2受体拮抗剂托伐普坦对包括心脏和非心脏疾病患者在内的危重症患者的潜在利尿效果。这是一项单中心回顾性观察研究。我们分析了我院2019 - 2020年入住重症监护病房（ICU）≥4天、在入住ICU前未接受肾移植或永久性肾脏替代治疗的成年危重症患者（n = 473）的数据，包括非心脏疾病和心脏疾病患者。通过调整几个混杂因素（患者的疾病严重程度、合并症包括心脏病以及使用的利尿剂），我们应用多变量逻辑回归模型估计了每日尿量相比最小值增加两倍或更多的患者的预测因素（主要终点）。我们还使用广义估计方程模型研究了托伐普坦对血清肌酐（sCr）水平随时间变化的影响（次要终点）。使用托伐普坦与尿量增加显著相关（优势比[OR] 1.86，95%置信区间1.13 - 3.06，p = 0.015），但与sCr水平的时间变化无显著关联：β估计值[95%置信区间]，0.07[-0.01至0.15]，p = 0.08。托伐普坦能独立增加尿量，在包括心脏和非心脏疾病患者在内的危重症患者中显然不会使肾功能恶化。
