Urine Osmolality Estimated Using Urine Urea Nitrogen, Sodium and Creatinine Can Effectively Predict Response to Tolvaptan in Decompensated Heart Failure Patients

Teruhiko Imamura; Koichiro Kinugawa; Shun Minatsuki; Hironori Muraoka; Naoko Kato; Toshiro Inaba; Hisataka Maki; Taro Shiga; Masaru Hatano; Atsushi Yao; Shunei Kyo; Issei Komuro

doi:10.1253/circj.CJ-12-1328

Heart Failure

Urine Osmolality Estimated Using Urine Urea Nitrogen, Sodium and Creatinine Can Effectively Predict Response to Tolvaptan in Decompensated Heart Failure Patients

Teruhiko Imamura, Koichiro Kinugawa, Shun Minatsuki, Hironori Muraoka, Naoko Kato, Toshiro Inaba, Hisataka Maki, Taro Shiga, Masaru Hatano, Atsushi Yao, Shunei Kyo, Issei Komuro

Author information

Teruhiko Imamura
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Koichiro Kinugawa
Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
Shun Minatsuki
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Hironori Muraoka
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Naoko Kato
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Toshiro Inaba
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Hisataka Maki
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Taro Shiga
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Masaru Hatano
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Atsushi Yao
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Shunei Kyo
Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
Issei Komuro
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo

Keywords: Hyponatremia, Responder, Vasopressin

JOURNAL FREE ACCESS

2013 Volume 77 Issue 5 Pages 1208-1213

DOI https://doi.org/10.1253/circj.CJ-12-1328

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Abstract

Background: Urine osmolality (U-OSM) is valuable to predict response to tolvaptan (TLV) in decompensated heart failure patients, but measurement of U-OSM is not always available on site. Methods and Results: Data were collected from 66 hospitalized patients with decompensated heart failure who had received TLV at 3.75–15mg/day. U-OSM, which was estimated using the following formula: 1.07×{2×[(urine sodium (mEq/L)]+[urine urea nitrogen (mg/dl)]/2.8+[urine creatinine (mg/dl)]×2/3}+16, was well correlated with the actual measurement (r=0.938, P<0.001). Criteria consisting of C1 (estimated baseline U-OSM >358mOsm/L) and C2 (%decrease in estimated U-OSM >24% at 4–6h after the first TLV dose) significantly discriminated responders from non-responders (P<0.05). Conclusions: Response to TLV can be predicted using U-OSM, which can be estimated using urine urea nitrogen, sodium, and creatinine concentration data. (Circ J 2013; 77: 1208–1213)

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