The efficacy of tolvaptan in the perioperative management of chronic kidney disease patients undergoing open-heart surgery

• Published in: Surgery today (Tokyo, Japan) Vol. 47; no. 4; pp. 498 - 505
• Main Authors: Yamada, Mitsutomo, Nishi, Hiroyuki, Sekiya, Naosumi, Horikawa, Kohei, Takahashi, Toshiki, Sawa, Yoshiki
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-04-2017
• Subjects: Aged; Aged, 80 and over; Antidiuretic Hormone Receptor Antagonists - administration & dosage; Benzazepines - administration & dosage; Cardiac Surgical Procedures; Female; Glomerular Filtration Rate; Heart Diseases - complications; Heart Diseases - surgery; Humans; Male; Medicine; Medicine & Public Health; Original Article; Perioperative Care; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - drug therapy; Renal Insufficiency, Chronic - physiopathology; Surgery; Surgical Oncology; Urination; Tolvaptan; Chronic kidney disease; Perioperative care; Open-heart surgery
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-016-1406-5

Purpose
The perioperative management of chronic kidney disease (CKD) patients undergoing open-heart surgery is challenging. In this study, we evaluated the effects of tolvaptan in CKD patients after open-heart surgery.
Methods
Between 2010 to 2015, 731 patients underwent open-heart surgery in our hospital. We consecutively selected 71 patients with stage IIIa–IV CKD and divided them into two groups. Those who received tolvaptan postoperatively were defined as the “Tolvaptan group” (
n
 = 25) and those who did not were defined as the “Non-tolvaptan group” (
n
 = 46). We compared the urine volume of postoperative days (POD) 1 and 2, the number of days to return to preoperative body weight (BW), and the change in the postoperative estimated glomerular filtration rate (eGFR).
Results
In the tolvaptan group, the urine volume was significantly larger (
P
 = .04) and the duration to preoperative BW tended to be shorter. Overall, the postoperative change in the eGFR tended to be better in the tolvaptan group (
P
 = .008). In particular, we found a significantly better trend in CKD stage IV (
P
 = .04) patients and in the patients, whose cardiopulmonary bypass (CPB) time was longer than 120 min (
P
 = .03).
Conclusions
Tolvaptan can safely be used for CKD patients undergoing open-heart surgery and can provide a feasible urine volume without leading to a deterioration of their renal function.