Tolvaptan response predictors in acute heart failure patients with congestion

Tolvaptan has been used in many countries as an adjunct to diuretic therapy for heart failure. The identification of predictors of response to tolvaptan is essential in developing individual treatment plans, and this study therefore aims to identify responders and predictors to the use of this treatment. A total of 75 acute heart failure patients with congestion receiving tolvaptan were analyzed retrospectively. Clinical parameters after tolvaptan treatment were evaluated to provide an overview of the effectiveness and safety of tolvaptan. A predictive model was created, and logistic regression analysis was performed. The criterion for diuresis response was peak fluid balance of >−1000 ml, while the criterion for sodium response was >3.5 mEq/l sodium increase. Clinical parameters of urine volume and fluid balance before and after tolvaptan did not differ significantly, but serum creatinine, eGFR, sodium, potassium, and blood pressure were significantly different. Hypernatremia occurred in one patient. Multivariate analysis of all samples showed that diabetes (OR=4.856; P=0.006) and systolic blood pressure (SBP) (OR=1.031; P=0.046) affected diuresis response. Analysis in hyponatremic patients demonstrated that sex (OR=0.159; P=0.033) and serum sodium (OR=0.83; P=0.045) affected sodium response. Administration of tolvaptan significantly changed serum creatinine, eGFR, sodium, potassium, and blood pressure. The predictors for diuresis responders were the absence of type 2 diabetes and having higher baseline SBP, while the predictors for sodium responders were being male and having lower baseline serum sodium levels.