Tolvaptan-induced hypernatremia related to low serum potassium level accompanying high blood pressure in patients with a
- PDF / 1,141,229 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 57 Downloads / 159 Views
RESEARCH ARTICLE
Open Access
Tolvaptan‑induced hypernatremia related to low serum potassium level accompanying high blood pressure in patients with acute decompensated heart failure Hidetada Fukuoka, Koichi Tachibana, Yukinori Shinoda, Tomoko Minamisaka, Hirooki Inui, Keisuke Ueno, Soki Inoue, Kentaro Mine, Kumpei Ueda and Shiro Hoshida*
Abstract Backgrounds: Tolvaptan significantly increases urine volume in acute decompensated heart failure (ADHF); serum sodium level increases due to aquaresis in almost all cases. We aimed to elucidate clinical factors associated with hypernatremia in ADHF patients treated with tolvaptan. Methods: We enrolled 117 ADHF patients treated with tolvaptan in addition to standard therapy. We examined differences in clinical factors at baseline between patients with and without hypernatremia in the initial three days of hospitalization. Results: Systolic (p = 0.045) and diastolic (p = 0.004) blood pressure, serum sodium level (p = 0.002), and negative water balance (p = 0.036) were significantly higher and serum potassium level (p = 0.026) was significantly lower on admission day in patients with hypernatremia (n = 22). In multivariate regression analysis, hypernatremia was associ‑ ated with low serum potassium level (p = 0.034). Among patients with serum potassium level ≤ 3.8 mEq/L, the cutoff value obtained using receiver operating characteristic curve analysis, those with hypernatremia related to tolvaptan treatment showed significantly higher diastolic blood pressure on admission day (p = 0.004). Conclusion: In tolvaptan treatment combined with standard therapy in ADHF patients, serum potassium level ≤ 3.8 mEq/L may be a determinant factor for hypernatremia development. Among hypokalemic patients, those with higher diastolic blood pressure on admission may be carefully managed to prevent hypernatremia. Keywords: Acute decompensated heart failure, Hypernatremia, Hypokalemia, Tolvaptan Backgrounds Tolvaptan, a selective V2 receptor antagonist with an aquaretic effect, significantly increases urine volume without increasing electrolyte excretion into the urine in acute decompensated heart failure (ADHF) [1–3]. Tolvaptan can decrease body weight, increase serum *Correspondence: shiro.hoshida@hosp‑yao.osaka.jp Department of Cardiovascular Medicine, Yao Municipal Hospital, 1‑3‑1 Ryuge‑cho, Yao, Osaka 581‑0069, Japan
sodium level, and ameliorate some congestion symptoms in patients with ADHF, which may help prevent overdose of loop diuretics, especially in patients with renal dysfunction [4]. A meta-analysis of the published literature suggests short-term benefits of tolvaptan, but the impact on mortality is inconclusive [4–7]. The serum sodium level increases as a result of aquaresis in almost all cases, and hypernatremia can be lethal in some patients [8, 9] and was identified as a significant adverse event to be prevented [10]. Therefore, a lower dose of tolvaptan to
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International
Data Loading...
