Abstract 10014: The Impact of Fractional Excretion of Potassium, a Possible Marker of Renin-angiotensin-aldosterone Activation or Low Output, on the Survival Rate of Heart Failure Patients Treated With Tolvaptan
Introduction: Although hyponatremia is known to negatively impact on survival in heart failure, sodium (Na) sparing aquaresis by tolvaptan (TLV) failed to demonstrate survival benefit.
Hypothesis: We hypothesized TLV may reduce GFR or activate renin-angiotensin-aldosterone (RAAS) system via augmentation of intravascular free water clearance, therefore, these compensational mechanism may exacerbate the prognosis in heart failure.
Methods: A retrospective cohort design was used to assess 82 patients treated with TLV. We analyzed intravascular free water clearance, serum Na change, and fractional excretion of potassium (FEK), which correlates RAAS activation or GFR reduction.
Results: Positive intravascular free water clearance significantly correlated with increases in serum Na. TLV tended to increase FEK in all groups. However, there was significant deference in the increase rate of FEK between short-term administration group and other groups, especially in poor prognostic groups as follows: the necessity of surgical intervention or renal replacement therapy (ex. ventricular asssist device, valve replacement or hemodialysis) or death, 5.5 vs 5.7%, 25.3 vs 35.3%, 28.9 vs 106.2%, respectively.
Conclusions: Long-term administration of TLV reduces intravascular free water, sodium excretion, urine volume and GFR and in turn activates RAAS. FEK can be a useful biomarker for detection of RAAS activation/ GFR reduction in patients treated with TLV.
Author Disclosures: K. Hiasa: None. T. Fujino: None. T. Sakamoto: None. T. Ide: None. T. Higo: None.
- © 2015 by American Heart Association, Inc.