Abstract 13557: Tolvaptan Improves Water Retention in Children Especially with Single Ventricle Physiology
Background: Tolvaptan, V2 receptor antagonist, is a new diuretics which has been shown to be effective in adult heart failure (HF) and hyponatulamia. However, little is known about safety and efficacy of tolvaptan in children.
Excessive water retention such as ascites and pleural effusion in protein losing enteropathy (PLE) and post Glen procedure(BDG), are often difficult to control with standard diuretics.
Purpose: This study was to clarify the safety and efficacy of tolvaptan in children with congenital heart disease (CHD) especially in single ventricule physiology.
Method: Multi-center retrospective chart review was carried out on CHD patients (Pt) younger than 18 yeas old and were on tolvaptan (n=28). Serum sodium (Na) and urine output were measured pre, post 1day(D), 3D, and 7D of tolvaptan use. Urine osmotic pressure,kidney and liver function were compared pre and post administration of tolvaptan. As comparison, adult CHD patients who were started tolvaptan were also reviewed (n=8).
Results: Tolvaptan was used for HF in 13Pt, and PLE/BDG in 15Pt at 5 centers. All patients were on furosemide. Urine output was significantly improved (one way ANOVA p<0.0001), and was considered effective in 90%. Of note, degree of urine output increment was significantly better in PLE/GDB compared to HF (figure 1.). Hyponatulamia(<135mEq/L) was noted in 14 patients, and Na was significantly increased (paired t-test p=0.02) but within normal range. Urine osmolality was significantly decreased (paired t-test p=0.01).
Dehydration was the only adverse effect noted in 2 Pt. Kidney and liver function were unchanged.
Conclusion: Tolvaptan can be used safely in children without significant adverse effect and was considered effective as diuretics in 90% of the cases. Tolvaptan may be especially effective to control water retention in patients with single ventricle physiology complicated with pleural effusion and/or PLE.
- © 2013 by American Heart Association, Inc.