发布日期：2013 年 2 月
英文标题：Tolvaptan reduces the risk of worsening renal function in patients with acute decompensated heart failure in high-risk population.
作者：Matsue Y, Suzuki M, Seya M, Iwatsuka R, Mizukami A, Nagahori W, Ohno M, Matsumura A, Hashimoto Y.
出处：J Cardiol. 2013 Feb;61(2):169-74.
内容介绍：该研究选择急性失代偿性心衰（ADHF）并有肾功能恶化（WRF）高危因素的患者，危险因素评分采用 Forman 评分系统，分数 ≥ 2 的患者入选。心衰诊断依据 Framingham 标准。结果显示，托伐普坦治疗组肾损伤的发生率为 22.7%，远低于传统治疗组的 41.4%（P<0.05）。因此，托伐普坦对于心衰伴有肾功能衰竭患者安全、有效，对于有肾损伤高危因素的心衰患者能够产生更多尿量，而不导致肾损伤。
摘要展示：
BACKGROUND: Although tolvaptan is a recently approved drug for heart failure and causes aquaresis without affecting renal function, its clinical efficacy for patients with acute decompensated heart failure (ADHF) is yet to be elucidated.
METHODS AND RESULTS: We conducted a prospective observational study in patients with ADHF and high risk for worsening renal function (WRF). Risk stratification for WRF was done by scoring system. Of 174 patients, 114 patients were included as high-risk population for WRF. Incidence of WRF, urine output within 24 h and 48 h, and changes in brain natriuretic peptide (BNP) were recorded in 44 patients treated with tolvaptan plus conventional therapy, and 70 patients with only conventional therapy. Urine output at 24 h and 48 h after admission were both significantly higher in the tolvaptan group (p = 0.001 and <0.001, respectively), and changes in BNP were not significantly different (p = 0.351). However, the incidence of WRF was significantly lower in the tolvaptan group compared to the conventional group (22.7% vs 41.4%, p = 0.045). Logistic regression analysis showed that treatment with tolvaptan was an independent factor for reducing WRF (hazard ratio 0.28, 95% confidence interval; 0.10-0.84; p = 0.023).
CONCLUSION: In patients with ADHF with high risk of WRF, treatment with tolvaptan could prevent WRF compared to conventional therapy.
