The Use of Tolvaptan to Prevent Renal Dysfunction in High Risk Patients With Heart Failure-Pilot Study

Withdrawn before enrolling · Phase 4 · Has a placebo group

Conditions studied: Heart Failure

In brief

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.

Key facts

Study ID

NCT01663662

Run by

University of Michigan

People needed

0

Starts

2012-08-01

Expected to finish

2013-11-01

Last updated by the study team

2015-12-11

Who can join

Age: 18 and older, up to 99. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• ≥ 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

You may not qualify if…

• 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.

Where it is running

• University of Michigan Health Systems — Ann Arbor, Michigan, United States

Full record on ClinicalTrials.gov

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