Successful Treatment with Tolvaptan to Control Blood Volume and Hyponatremia in a Chronic Kidney Disease Patient

Overview

Journal CEN Case Rep

Specialty Nephrology

Date 2017 May 17

PMID 28509063

Citations 1

Authors

Tomoyuki Yamazaki

Yoshiyuki Morishita

Naoki Yoshida

Osamu Saito

Fumi Takemoto

Yasuhiro Ando

Shigeaki Muto

Wako Yumura

Eiji Kusano

Affiliations

Soon will be listed here.

Abstract

We report a case of successful treatment with tolvaptan (15 mg/day) in a 73-year-old female patient with chronic kidney disease (CKD) stage 5 due to diabetic nephropathy and renal sclerosis for volume control and loop diuretic-induced hyponatremia. Her creatinine clearance has remained at 7-10 ml/min for the last 6 months. She was treated by dietary and drug therapy, namely, antihypertensives (nifedipine: 40 mg/day, olmesartan: 20 mg/day) and loop diuretics (azosemide: 40-120 mg/day), for CKD and concomitant diseases of hypertension and diabetic mellitus. She developed loop diuretic-induced hyponatremia (120 mmol/l) by increased sodium excretion, but the diuretic was required for the control of volume overload. Hence, azosemide was suspended and tolvaptan (15 mg/day) was administered. After tolvaptan treatment, the plasma sodium level gradually increased to a normal level (135-140 mmol/l) and volume overload was improved. Urine volume was maintained at about 1000 ml/day with low sodium excretion (<40 mmol/day) and increased free water clearance. These results suggest that tolvaptan may be effective for volume control and diuretic-induced hyponatremia in CKD patients.

Citing Articles

Dual Impact of Tolvaptan on Intracellular and Extracellular Water in Chronic Kidney Disease Patients with Fluid Retention.

Masuda T, Murakami T, Igarashi Y, Okabe K, Kobayashi T, Takeda S Intern Med. 2016; 55(19):2759-2764.

PMID: 27725533 PMC: 5088534. DOI: 10.2169/internalmedicine.55.7133.

References

Irazabal M, Torres V, Hogan M, Glockner J, King B, Ofstie T . Short-term effects of tolvaptan on renal function and volume in patients with autosomal dominant polycystic kidney disease. Kidney Int. 2011; 80(3):295-301. DOI: 10.1038/ki.2011.119. View

Yamamura Y, Nakamura S, Itoh S, Hirano T, Onogawa T, Yamashita T . OPC-41061, a highly potent human vasopressin V2-receptor antagonist: pharmacological profile and aquaretic effect by single and multiple oral dosing in rats. J Pharmacol Exp Ther. 1998; 287(3):860-7. View

Londono M, Guevara M, Rimola A, Navasa M, Taura P, Mas A . Hyponatremia impairs early posttransplantation outcome in patients with cirrhosis undergoing liver transplantation. Gastroenterology. 2006; 130(4):1135-43. DOI: 10.1053/j.gastro.2006.02.017. View

. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002; 39(2 Suppl 1):S1-266. View

BUCKALEW Jr V, Berg R, Wang S, Porush J, Rauch S, Schulman G . Prevalence of hypertension in 1,795 subjects with chronic renal disease: the modification of diet in renal disease study baseline cohort. Modification of Diet in Renal Disease Study Group. Am J Kidney Dis. 1996; 28(6):811-21. DOI: 10.1016/s0272-6386(96)90380-7. View

Berl T, Quittnat-Pelletier F, Verbalis J, Schrier R, Bichet D, Ouyang J . Oral tolvaptan is safe and effective in chronic hyponatremia. J Am Soc Nephrol. 2010; 21(4):705-12. PMC: 2844305. DOI: 10.1681/ASN.2009080857. View

Waikar S, Mount D, Curhan G . Mortality after hospitalization with mild, moderate, and severe hyponatremia. Am J Med. 2009; 122(9):857-65. PMC: 3033702. DOI: 10.1016/j.amjmed.2009.01.027. View

Goldberg A, Hammerman H, Petcherski S, Nassar M, Zdorovyak A, Yalonetsky S . Hyponatremia and long-term mortality in survivors of acute ST-elevation myocardial infarction. Arch Intern Med. 2006; 166(7):781-6. DOI: 10.1001/archinte.166.7.781. View

Konstam M, Gheorghiade M, Burnett Jr J, Grinfeld L, Maggioni A, Swedberg K . Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial. JAMA. 2007; 297(12):1319-31. DOI: 10.1001/jama.297.12.1319. View

10.

Wu C, Yeung L, Tsai W, Tseng C, Chu P, Huang T . Incidence and factors predictive of acute renal failure in patients with advanced liver cirrhosis. Clin Nephrol. 2006; 65(1):28-33. DOI: 10.5414/cnp65028. View

11.

Chow K, Kwan B, Szeto C . Clinical studies of thiazide-induced hyponatremia. J Natl Med Assoc. 2004; 96(10):1305-8. PMC: 2568543. View

12.

Irie F, Iso H, Sairenchi T, Fukasawa N, Yamagishi K, Ikehara S . The relationships of proteinuria, serum creatinine, glomerular filtration rate with cardiovascular disease mortality in Japanese general population. Kidney Int. 2006; 69(7):1264-71. DOI: 10.1038/sj.ki.5000284. View

13.

Higashihara E, Torres V, Chapman A, Grantham J, Bae K, Watnick T . Tolvaptan in autosomal dominant polycystic kidney disease: three years' experience. Clin J Am Soc Nephrol. 2011; 6(10):2499-507. PMC: 3359559. DOI: 10.2215/CJN.03530411. View

14.

Moist L, Port F, Orzol S, Young E, Ostbye T, Wolfe R . Predictors of loss of residual renal function among new dialysis patients. J Am Soc Nephrol. 2000; 11(3):556-564. DOI: 10.1681/ASN.V113556. View

15.

Augustyniak R, Tuncel M, Zhang W, Toto R, Victor R . Sympathetic overactivity as a cause of hypertension in chronic renal failure. J Hypertens. 2002; 20(1):3-9. DOI: 10.1097/00004872-200201000-00002. View

16.

McCurley J, Hanlon S, Wei S, Wedam E, Michalski M, Haigney M . Furosemide and the progression of left ventricular dysfunction in experimental heart failure. J Am Coll Cardiol. 2004; 44(6):1301-7. DOI: 10.1016/j.jacc.2004.04.059. View

17.

Schrier R, Gross P, Gheorghiade M, Berl T, Verbalis J, Czerwiec F . Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N Engl J Med. 2006; 355(20):2099-112. DOI: 10.1056/NEJMoa065181. View