Fluid retention and heart failure9/28/2023 ![]() ![]() Differences in the scopes, methods of analysis, and methodological quality of SRs/MAs can cause great confusion and make it difficult for policy makers and clinicians to access and interpret the available evidence and for researchers to know where knowledge gaps in the extant literature exist. Accordingly, tolvaptan may be appropriate for HF patients with electrolyte disturbance and poor response to conventional diuretics.Ĭurrently, growing interest in the effects of tolvaptan on patients with water retention caused by HF has led to a continuous increase in the number of related SRs/MAs on this topic. Several clinical trials have provided mechanistic support for the symptomatic improvements and normalized serum sodium noted with tolvaptan in patients with decompensated HF. Tolvaptan is a selective antagonist of the vasopressin V2 receptor whose action on the renal collecting ducts inhibits vasopressin-mediated water re-absorption. According to current guidelines, for patients with HF who have fluid retention, diuretics are recommended to relieve congestion, improve symptoms and prevent worsening HF, despite diuretic resistance and the potential adverse effects that would be related to electrolyte disturbance, impairment of renal function and activation of the renin angiotensin aldosterone system(RAAS). As the vital role of reliving congestion played, diuretics are the cornerstone of therapy in HF. Sustained high volume loading due to water retention caused by reduced ejection is one of the most dangerous pathophysiological processes in HF, resulting in patients' dyspnea and even death. Currently, the absolute numbers of HF prevalent cases and years lived with disability(YLDs) have increased by 91.9% and 106.0% from 1990, respectively. Heart failure (HF) is a complex clinical syndrome derived from any structural or functional impairment of ventricular filling or ejection of blood. Tolvaptan can be recommended for water retention in HF patients, but more evidence is needed. The result of GRADE assessment was not optimistic, so the overall quality of the evidences was low as well. ![]() Besides, every article had a few non-critical item defects too. all the 9 articles were rated as low-quality because AMSTAR 2 evaluation showed that they each had at least one critical item (items 2, 4, 7, 9, 11, 13 and 15) defect. It was pessimistic when it comes to the quality of the 9 studies. Through conducting forest plots, it appeared that tolvaptan brought more positive effect than conventional therapies. Serum sodium concentration and urine output were considered as primary outcomes and body weight change and all-cause mortality as second outcomes. ResultsĪ total of 9 SRs/Mas between 2015 to 2020 met inclusion criteria. The methodological and evidence quality were respectively evaluated by AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews 2) and GRADE (Grading of Recommendation of Assessment, Development, and Evaluation) system. Revman 5.3 was used to make forest plots to show the characteristics of outcomes. Standardized forms were used to extract data. All the records were managed with Endnote 20. MethodsĪ comprehensive literature search was performed on PubMed, EMBASE, web of science, Cochrane reviews for SRs/Mas published between the databases’ establishment to November 17, 2021. The purpose of this systematic review is to collect, appraise, and synthesize existing evidence from systematic reviews and meta-analyses (SRs/MAs) on the effectiveness of tolvaptan for water retention in heart failure.
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