Siroz ve kalp yetmezliği olan hastalarda tolvaptanın erken dönemde hiponatremi üzerindeki etkinliği ve güvenliği

Öz

Giriş: Siroz ve kalp yetmezliği olan hastalarda hiponatremi sık görülen bir elektrolit bozukluğudur. Bu çalışmada bir vazopressör V2 reseptör antagonisti olan tolvaptan`ın sirotik hastalarda ve kalp yetmezliği olan hastalarda serum sodyum (Na) değeri üzerindeki etkisinin araştırılması amaçlanmıştır. Materyal metod: Ocak 2018 – Haziran 2020 tarihleri arasında Harran Üniversitesi Tıp Fakültesi Hastanesi Gastroenteroloji ve Kardiyoloji kliniklerinde takip edilen, hiponatremi nedeniyle tolvaptan verilen 59 hasta değerlendirildi. Hastalara 15 mg tolvaptan verildikten sonra 0., 3. ve 5. günlerdeki Na değerleri incelendi. Bulgular: Toplam 59 hastanın 41`i (%70) kalp yetmezliği, 18`i (%30) siroz idi. Hastaların 35`i (%59) kadın, yaş ortalaması 67.06 ± 13.35, yaş dağılımı 21 - 89 idi. Siroz hastalarında 0., 3. ve 5. günlerdeki Na değerleri sırasıyla 120.94 ± 3.88, 125.94 ± 4.20, 128.61 ± 5.58 (dağılımı sırasıyla 113–128, 120 – 134, 118 – 138) mEq/L olup, 3. ve 5. günlerde Na anlamı olarak yükselmiştir (p<0,000, p<0,0166). Kalp yetmezliği olan hastalarda 0., 3. ve 5. günlerdeki Na değerleri sırasıyla 128.68 ± 7.32, 133.43 ± 4.61, 132.77 ± 5 (dağılımı sırasıyla 111 – 143, 124 – 142, 123 – 146) mEq/L olup, 3. günde Na artışı anlamlı iken (p<.0,0166), 3 ve 5.gün arası Na artış değeri anlamlı olarak yükselmemiştir (p>0.587). Tedaviyi kesmeyi gerektirecek ciddi tan etki ve hipernatremi gelişmemiştir. Sonuç: Tolvaptan sirozlu hastalarda, Na’yı başlangıç değerine göre 3. ve 5. günde anlamlı olarak yükseltmiştir. Kalp yetmezliğinde ise Na’yı 3.günde anlamlı yükseltirken 3.ve 5.gün arasında anlamlı yükselme sağlamamıştır. Tolvaptan sirotik ve kalb yetmezliği olan hiponatremik hastalarda erken dönemde etkili ve güvenlidir.

Anahtar Kelimeler

• siroz
• kalp yetmezliği
• tolvaptan
• hiponatremi

Efficacy and safety of tolvaptan on hyponatremia in patients with cirrhosis and heart failure

Öz

Introduction: Hyponatremia is a common electrolyte disorder in patiients with cirrhosis and heart failure. In this study, it was aimed to invastgate the effect of tolvaptan, a vasopressor antagonist, on serum sodium (Na) value in hyponatremic cirrhotic and heart failure patients. Material method: 59 patients who were followed up in Harran University Medical Faculty Hospital, Gastroenterology and Cardiology clinics between January 2018 – June 2020 and given tolvaptan due to hyponatremia were evaluated. After giving 15 mg of tolvaptan to patients, Na values at 0, 3 and 5 days were examined. Results: A total of 59 patients, 41 (70%) had heart failure, 18 (30%) had cirrhosis. 35 (59%) of the patients were female, mean age was 67.06 ± 13.35, and age distribution was 21-89 years. Na values at 0, 3, and 5 days in patients with cirrhosis are 120.94 ± 3.88, 125.94 ± 4.20, 128.61 ± 5.58 (distribution 113–128, 120 - 134, 118 - 138, respectively) and 3 and 5. days increased as meaning (p <0.000, p <0.0166). Na values at 0, 3 and 5 days in patients with heart failure are 128.68 ± 7.32, 133.43 ± 4.61, 132.77 ± 5 (distribution is 111 - 143, 124 - 142, 123 - 146, respectively) and on day 3 while Na increase was significant (p <.0.0166), Na increase value between 3 and 5 days did not increase significantly (p> 0.587). Serious adverse effects and hypernatremia that would require discontinuation of treatment have not developed. Conclusion: In cirrhotic patients with tolvaptan, Na increased significantly according to baseline on the 3rd and 5th days. In heart failure patients, Na significantly increased on the 3rd day, but did not increase significantly between the 3rd and 5th days. Tolvaptan is effective and safe in the early period in patients with hyponatremic cirrhotic and heart failure.

Anahtar Kelimeler

• cirrhosis
• heart failure
• tolvaptan
• hyponatremia

Kaynakça

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