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Background:  Given that residual congestion is a predictor of poor outcome in patients with heart failure (HF), a therapeutic strategy for decongestion is required.  Methods and Results:  Eighteen HF patients with fluid retention despite oral furosemide &gt;20 mg/day, with chronic kidney disease (CKD; estimated glomerular filtration rate [eGFR], &lt;59 mL/min/1.73 m 2 ) were enrolled. Patients were randomized into 2 groups: a tolvaptan group (tolvaptan, 7.5 mg/day, n=10) and a furosemide group (additional furosemide 20 mg/day, n=8), and followed up for 7 days. The urine volume significantly increased on day 3 in the tolvaptan group but not in the furosemide group. The body weight significantly decreased in the tolvaptan compared with the furosemide group on days 3 and 5. Although there was no difference in serum creatinine or eGFR in the 7 days between the 2 groups, serum cystatin C significantly decreased on day 7 in the tolvaptan group compared with the furosemide group. The residual congestion was more improved in the tolvaptan group than in the furosemide group.  Conclusions:  Adding tolvaptan but not furosemide significantly increased urine volume, decreased body weight and improved residual congestion without affecting the renal function or electrolytes in patients with HF with CKD under furosemide treatment.

Addition of Tolvaptan Compared With Increased Dose of Furosemide in Heart Failure Patients With Chronic Kidney Disease Under Furosemide Treatment