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Early introduction of tolvaptan after cardiac surgery: a renal sparing strategy in the light of the renal resistive index measured by ultrasound.

Kato TS, Ono S, Kajimoto K, Kuwaki K, Yamamoto T, Amano A - J Cardiothorac Surg (2015)

Bottom Line: The 2(nd) RI value was higher in Group T than Group L (0.77 ± 0.09 vs. 0.69 ± 0.01, p = 0.049) but significantly decreased after tolvaptan administration [0.77 ± 0.09 to 0.65 ± 0.05 (2(nd) to 3(rd)), to 0.62 ± 0.04 (to 4(th)), both p = 0.006], while no such changes were seen in Group L.The serum sodium and albumin levels, and echo-derived tricuspid annular plane systolic excursion increased only in Group T (134.1 ± 1.5 to 138.8 ± 3.2 mEq/L, 3.3 ± 0.3 to 3.7 ± 0.5 g/dL, 16.4 ± 3.6 to 19.7 ± 4.2 mm, all p <0.05).The duration of IV loop diuretics tended to be shorter in Group T than Group L (5.6 ± 1.6 vs. 8.7 ± 3.6 days, p = 0.051).

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. tokato@juntendo.ac.jp.

ABSTRACT

Background: Renal failure is a serious complication after cardiac surgery, which can be caused by long-term intravenous (IV) loop diuretic use. Tolvaptan is an oral selective vasopressin-2 receptor antagonist used in patients irresponsive to loop diuretics. We investigated their renal perfusion changes using the resistive index (RI) postoperatively.

Methods: Serial renal RI, echocardiography, and laboratory examinations from 14 patients requiring continuous postoperative IV loop diuretics were reviewed. Eight patients received tolvaptan (Group T) and six received oral loop diuretics before the discontinuation of IV loop diuretics (Group L). The 1(st) data were obtained between postoperative day 0 and 2, the 2(nd) when patients were still under IV loop diuretic treatment, the 3(rd) after the initiation of tolvaptan or oral loop diuretic, and the 4(th) after the discontinuation of IV diuretics.

Results: The 2(nd) RI value was higher in Group T than Group L (0.77 ± 0.09 vs. 0.69 ± 0.01, p = 0.049) but significantly decreased after tolvaptan administration [0.77 ± 0.09 to 0.65 ± 0.05 (2(nd) to 3(rd)), to 0.62 ± 0.04 (to 4(th)), both p = 0.006], while no such changes were seen in Group L. The serum sodium and albumin levels, and echo-derived tricuspid annular plane systolic excursion increased only in Group T (134.1 ± 1.5 to 138.8 ± 3.2 mEq/L, 3.3 ± 0.3 to 3.7 ± 0.5 g/dL, 16.4 ± 3.6 to 19.7 ± 4.2 mm, all p <0.05). The duration of IV loop diuretics tended to be shorter in Group T than Group L (5.6 ± 1.6 vs. 8.7 ± 3.6 days, p = 0.051).

Conclusions: Administration of tolvaptan in patients undergoing cardiac surgery may improve their renal perfusion, as reflected by the renal RI measured using renal Doppler ultrasound.

No MeSH data available.


Related in: MedlinePlus

A flow chart of treatment strategies in patients included in the study. WRF worsening of renal function, IV intravenous, echo echocardiography and renal ultrasound
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Fig1: A flow chart of treatment strategies in patients included in the study. WRF worsening of renal function, IV intravenous, echo echocardiography and renal ultrasound

Mentions: This is a retrospective study at an institution with no definite protocol for using tolvaptan as a part of the renal sparing strategy after cardiac surgery. Still, serial bedside echocardiography together with renal Doppler ultrasound is routinely performed postoperatively, and we aim to decrease the IV diuretic dosage if the patient’s renal RI value is over 0.7. In such cases, oral tolvaptan was initiated to maintain adequate urinary output while the IV diuretic dosage was reduced, if their serum sodium concentration was within a reasonable range and echocardiography did not indicate hypovolemic states (Fig. 1).Fig. 1


Early introduction of tolvaptan after cardiac surgery: a renal sparing strategy in the light of the renal resistive index measured by ultrasound.

Kato TS, Ono S, Kajimoto K, Kuwaki K, Yamamoto T, Amano A - J Cardiothorac Surg (2015)

A flow chart of treatment strategies in patients included in the study. WRF worsening of renal function, IV intravenous, echo echocardiography and renal ultrasound
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4631092&req=5

Fig1: A flow chart of treatment strategies in patients included in the study. WRF worsening of renal function, IV intravenous, echo echocardiography and renal ultrasound
Mentions: This is a retrospective study at an institution with no definite protocol for using tolvaptan as a part of the renal sparing strategy after cardiac surgery. Still, serial bedside echocardiography together with renal Doppler ultrasound is routinely performed postoperatively, and we aim to decrease the IV diuretic dosage if the patient’s renal RI value is over 0.7. In such cases, oral tolvaptan was initiated to maintain adequate urinary output while the IV diuretic dosage was reduced, if their serum sodium concentration was within a reasonable range and echocardiography did not indicate hypovolemic states (Fig. 1).Fig. 1

Bottom Line: The 2(nd) RI value was higher in Group T than Group L (0.77 ± 0.09 vs. 0.69 ± 0.01, p = 0.049) but significantly decreased after tolvaptan administration [0.77 ± 0.09 to 0.65 ± 0.05 (2(nd) to 3(rd)), to 0.62 ± 0.04 (to 4(th)), both p = 0.006], while no such changes were seen in Group L.The serum sodium and albumin levels, and echo-derived tricuspid annular plane systolic excursion increased only in Group T (134.1 ± 1.5 to 138.8 ± 3.2 mEq/L, 3.3 ± 0.3 to 3.7 ± 0.5 g/dL, 16.4 ± 3.6 to 19.7 ± 4.2 mm, all p <0.05).The duration of IV loop diuretics tended to be shorter in Group T than Group L (5.6 ± 1.6 vs. 8.7 ± 3.6 days, p = 0.051).

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. tokato@juntendo.ac.jp.

ABSTRACT

Background: Renal failure is a serious complication after cardiac surgery, which can be caused by long-term intravenous (IV) loop diuretic use. Tolvaptan is an oral selective vasopressin-2 receptor antagonist used in patients irresponsive to loop diuretics. We investigated their renal perfusion changes using the resistive index (RI) postoperatively.

Methods: Serial renal RI, echocardiography, and laboratory examinations from 14 patients requiring continuous postoperative IV loop diuretics were reviewed. Eight patients received tolvaptan (Group T) and six received oral loop diuretics before the discontinuation of IV loop diuretics (Group L). The 1(st) data were obtained between postoperative day 0 and 2, the 2(nd) when patients were still under IV loop diuretic treatment, the 3(rd) after the initiation of tolvaptan or oral loop diuretic, and the 4(th) after the discontinuation of IV diuretics.

Results: The 2(nd) RI value was higher in Group T than Group L (0.77 ± 0.09 vs. 0.69 ± 0.01, p = 0.049) but significantly decreased after tolvaptan administration [0.77 ± 0.09 to 0.65 ± 0.05 (2(nd) to 3(rd)), to 0.62 ± 0.04 (to 4(th)), both p = 0.006], while no such changes were seen in Group L. The serum sodium and albumin levels, and echo-derived tricuspid annular plane systolic excursion increased only in Group T (134.1 ± 1.5 to 138.8 ± 3.2 mEq/L, 3.3 ± 0.3 to 3.7 ± 0.5 g/dL, 16.4 ± 3.6 to 19.7 ± 4.2 mm, all p <0.05). The duration of IV loop diuretics tended to be shorter in Group T than Group L (5.6 ± 1.6 vs. 8.7 ± 3.6 days, p = 0.051).

Conclusions: Administration of tolvaptan in patients undergoing cardiac surgery may improve their renal perfusion, as reflected by the renal RI measured using renal Doppler ultrasound.

No MeSH data available.


Related in: MedlinePlus