The Use of Tolvaptan to Prevent Renal Dysfunction in High Risk Patients With Acute Decompensated Heart Failure-Pilot Study
试验速览
- 阶段
- 4 期
- 状态
- 撤回
- 试验地点
- 1
- 主要终点
- Renal dysfunction
研究概览
简要总结
It is well known that the use of loop diuretics in acute setting may decrease glomerular filtration rate (GFR) and increase serum creatinine leading to renal dysfunction. Loop diuretic induced elevation in serum creatinine can lead to increase in length of hospital stay and possibly morbidity. Previous studies have suggested that tolvaptan unlike aggressive loop diuretic therapy may not activate neurohormonal system nor decrease renal blood flow. These properties may make tolvaptan a useful addition to diuretic therapy to prevent renal dysfunction in high-risk patients. Therefore the primary objective of this study is to determine if the use of tolvaptan in combination with diuretic therapy may prevent development of renal dysfunction in high risk patients with heart failure.
Hypothesis: Administration of tolvaptan in combination with continuous loop diuretic therapy in acutely decompensated heart failure patients at high risk for developing diuretic induced renal dysfunction will have a lower proportion of patients increasing their serum creatinine > 0.3 mg/dL within a 96 hour time frame as compared to patients just receiving standard of care continuous infusion diuretic.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 99 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •≥ 18 years old
- •Prior clinical diagnosis of systolic heart failure (EF < 40% within the past 18 months) with daily home use of oral loop diuretic for at least one month.
- •Daily oral dose of furosemide ≥ 40 mg and ≤ 240 mg (or equivalent)
- •Identified within 24 hours of hospital admission
- •Heart failure defined by at least 1 symptom (dyspnea, orthopnea, or edema) AND 1 sign (rales on auscultation, peripheral edema, ascites, pulmonary vascular congestion on chest radiography)
- •Anticipated need for IV loop diuretics for at least 48 hours
- •Likely requires daily net urine output in the range of 1-3 L/day for over a 72-96 hour time period.
- •Albumin level < 3.5 g/dL
- •Willingness to provide informed consent
排除标准
- •Received or planned IV vasoactive treatment (inotropes, vasodilators) or ultra-filtration therapy for heart failure
- •BNP < 250 ng/ml or NT-proBNP < 1000 mg/ml (if drawn for clinical purposes)
- •Systolic BP < 90 mmHg
- •Serum creatinine > 3.0 mg/dl at baseline or renal replacement therapy or creatinine clearances < 10 mL/min
- •Serum sodium > 145 mEq/L
- •Acute coronary syndrome within 4 weeks
- •Anticipated need for coronary angiography or other procedures requiring IV contrast.
- •Patients receiving any of the following drugs: clarithromycin, ketoconazole, itraconazole,ritonavir, indinavir, nelfinavir, saquinavir, nefazodone, telithromycin, erythromycin, fluconazole, aprepitant, diltiazem, verapamil, cyclosporine, and grapefruit juice.
- •Pregnant or nursing patients.
研究组 & 干预措施
Tolvaptan Arm
Tolvaptan 30 mg qd x 3 days and Low Dose Loop Continuous Infusion - Initial Dosing:
Furosemide - 10 mg/hr Bumentanide - 0.25 mg/hr Torsemide - 5 mg/hr
干预措施: Tolvaptan (Drug)
Placebo
Placebo x 3 days and standard of care continuous infusion diuretic
干预措施: placebo (Drug)
结局指标
主要结局
Renal dysfunction
时间窗: 96 hours
Increase in serum creatinine \> 0.3 mg/dL within a 96 hours from enrollment
次要结局
- Weight(24, 78, 72, 96)
- Urine output(24, 48, 72, 96)
- Hospitalization length of stay(10)
研究者
Barry E. Bleske
Associate Professor
University of Michigan