Effect of tolvaptan on worsening renal function in patients with acute decompensated heart failure: a Meta-analysis

Ma Guang; Wang Guoliang; Xue Yongliang; Teng Wei; Hui Xuezhi.

doi:10.3969/j.issn.1674-4055.2019.06.05

Abstract：To review systematically the effects of tolvaptan used only, tolvaptan combined with loop diuretics or loop diuretics used only on incidence of worsening renal function (WRF) in patients with acute decompensated heart failure (ADHF). Methods The databases of Pub Med, EMbase, The Cochrane Library (Vol. 4, 2018), Wan Fang Data, CBM and CNKI were retrieved with computer for searching the randomized controlled trials (RCTs) about tolvaptan used only (tolvaptan group), tolvaptan combined with loop diuretics (combination group) or loop diuretics used only (loop diuretics group) in treatment of ADHF, and the retrieving duration was from database establishing time to Apr. 2018. The literature was screened according to inclusion and exclusion criteria, and data of WRF incidence, short-term mortality, decreased body weight and elevated blood sodium level were extracted by 2 researchers independently. After reviewed the risk of bias, all data was given a Meta-analysis by using Rev Man 5.3 software. Results There were totally 7 RCTs included involved 937 patients, and 466 in tolvaptan group and 471 in control group. The results of Meta-analysis showed that WRF incidence (RR=0.78, 95%CI: 0.48~1.26, P=0.31) and short-term mortality (RR=0.85, 95%CI: 0.47~1.56, P=0.61) were not decreased in tolvaptan group and combination group compared with loop diuretics group. The body weight within 2 d (SMD=-0.49, 95%CI:-0.64~-0.34, P<0.00001) was decreased and blood sodium level was increased in combination group. Conclusion Tolvaptan used only or tolvaptan combined with loop diuretics cannot reduce WRF incidence and in-hospital mortality, but can decrease body weight and increase blood sodium level compared with loop diuretics used only in ADHF patients. The conclusion should be verified by further studies due to the limitations of literature quality and quantity in this study.