The clinical effectiveness of tolvaptan in critically ill patients with or without heart disease: A retrospective observational study

Abstract

Abstract Background Strategies that achieve sufficient diuresis for critically ill patients are needed. Tolvaptan, a selective arginine vasopressin 2 receptor antagonist, has increased cardiac patients' urine volume without worsening their renal function, and we speculated that tolvaptan treatment may also do so in critically ill non-cardiac patients. Here, we sought to determine whether tolvaptan treatment provided sufficient diuresis in critically ill patients including those with and without cardiac disease, without increasing their serum creatine (sCr). Patients and Methods We retrospectively analyzed our institution's clinical data of critically ill adult patients (n = 477) with and without cardiac disease and with an ICU stay ≥ 4 days between 2019 and 2020. We used a logistic regression model to estimate the independent predictors of critically ill patients with sufficient diuresis (which we defined as a diuretic ratio [maximal – minimal urine values]/minimal value ≥ 1), associated with seven potential confounders including tolvaptan use. We also estimated the effect of tolvaptan on time-course changes in sCr by applying a generalized estimating equation model with nine potential confounders. Each outcome was analyzed in each cohort (i.e. all patients, those with cardiac disease, and those without cardiac disease). Results Tolvaptan use was a significant independent predictor of patients with a diuretic ratio ≥ 1 in each cohort (odds ratio [95%CI], all patients: 2.36 [1.5–3.7], p < 0.001, cardiac patients: 2.26 [1.33–3.84], p = 0.003; non-cardiac patients: 2.63 [1.11–6.22], p = 0.0028), but it was not significantly associated with time-course changes in the sCr (beta estimator [95%CI], all patients: 0.044 [− 0.026 to 0.114], p = 0.22, cardiac patients: 0.012 [− 0.077 to 0.10], p = 0.80, non-cardiac patients: 0.085 [− 0.027, 0.20], p = 0.14). Conclusions Tolvaptan treatment increased the urine volume without changing sCr in critically ill adults with and without cardiac disease. Trial registration Not applicable.