***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Diuretics are frequently required to treat fluid retention in patients with congestive heart failure ( CHF ) . Unfortunately , they can lead to a decline in renal function , electrolyte depletion , and neurohumoral activation . Arginine vasopressin ( AVP ) promotes renal water reabsorption via the V2 receptor , and its levels are increased in CHF . This study was design ed to assess the effects of a single oral dose of tolvaptan , a selective V2-receptor blocker , in the absence of other medications , on renal function in human CHF and to compare this to the effects of a single oral dose of furosemide . We hypothesized that V2-receptor antagonism would yield a diuresis comparable to furosemide but would not adversely affect renal hemodynamics , plasma electrolyte concentration , or neurohumoral activation in stable human CHF . Renal and neurohumoral effects of tolvaptan and furosemide were assessed in an open-label , r and omized , placebo-controlled crossover study in 14 patients with NYHA II-III CHF . Patients received placebo or 30 mg of tolvaptan on day 1 and were crossed over to the other medication on day 3 . On day 5 , all subjects received 80 mg of furosemide . Tolvaptan and furosemide induced similar diuretic responses . Unlike tolvaptan , furosemide increased urinary sodium and potassium excretion and decreased renal blood flow .  Tolvaptan , furosemide , and placebo did not differ with respect to mean arterial pressure , glomerular filtration rate , or serum sodium and potassium . We conclude that tolvaptan is an effective aquaretic with no adverse effects on renal hemodynamics or serum electrolytes in patients with mild to moderate heart failure BACKGROUND Loop diuretics used in the treatment of heart failure often induce renal impairment . This study was conducted in order to evaluate the renal protective effect of adding tolvaptan ( TLV ) , compared to increasing the furosemide ( FRM ) dose , for the treatment of acute decompensated heart failure ( ADHF ) in a real-world elderly patient population . METHODS This r and omized controlled trial enrolled 52 consecutive hospitalized patients ( age 83.4±9.6 years ) with ADHF . The patients were assigned alternately to either the TLV group ( TLV plus conventional treatment , n=26 ) or the FRM group ( increasing the dose of FRM , n=26 ) . TLV was administered within 24h from admission . RESULTS The incidence of worsening renal function ( WRF ) within 7 days from admission was significantly lower in the TLV group ( 26.9 % vs. 57.7 % , p=0.025 ) . Furthermore , the rates of occurrence of persistent and late-onset ( ≥5 days from admission ) WRF were significantly lower in the TLV group . Persistent and late-onset WRF were significantly associated with a higher incidence of cardiac death or readmission for worsening heart failure in the 90 days following discharge , compared to transient and early-onset WRF , respectively . CONCLUSIONS Early administration of TLV , compared to increased FRM dosage , reduces the incidence of WRF in real-world elderly ADHF patients . In addition , it reduces the occurrence of ' worse ' WRF-persistent and late-onset WRF-which are associated with increased rates of cardiac death or readmission for worsening heart failure in the 90 days after discharge BACKGROUND Although tolvaptan is a recently approved drug for heart failure and causes aquaresis without affecting renal function , its clinical efficacy for patients with acute decompensated heart failure ( ADHF ) is yet to be eluci date d. METHODS AND RESULTS We conducted a prospect i ve observational study in patients with ADHF and high risk for worsening renal function ( WRF ) . Risk stratification for WRF was done by scoring system . Of 174 patients , 114 patients were included as high-risk population for WRF .  Incidence of WRF , urine output within 24h and 48 h , and changes in brain natriuretic peptide ( BNP ) were recorded in 44 patients treated with tolvaptan plus conventional therapy , and 70 patients with only conventional therapy . Urine output at 24h and 48 h after admission were both significantly higher in the tolvaptan group ( p=0.001 and < 0.001 , respectively ) , and changes in BNP were not significantly different ( p=0.351 ) . However , the incidence of WRF was significantly lower in the tolvaptan group compared to the conventional group ( 22.7 % vs 41.4 % , p=0.045 ) . Logistic regression analysis showed that treatment with tolvaptan was an independent factor for reducing WRF ( hazard ratio 0.28 , 95 % confidence interval ; 0.10 - 0.84 ; p=0.023 ) . CONCLUSION In patients with ADHF with high risk of WRF , treatment with tolvaptan could prevent WRF compared to conventional therapy Purpose Diuretics are recommended to treat volume overload with heart failure ( HF ) , however , they may cause serum electrolyte imbalance , limiting their use . Moreover , patients with advanced HF could poorly respond to these diuretics . In this study , we evaluated the efficacy and safety of Tolvaptan , a competitive vasopressin V2-receptor antagonist developed as a new drug to treat volume overload in HF patients . Methods A phase III , multicenter , r and omized , double-blind , placebo-controlled parallel study was performed to assess the efficacy and safety of tolvaptan in treating HF patients with volume overload despite the use of conventional diuretics . One hundred and ten patients were r and omly assigned to receive either placebo or 15 mg/day tolvaptan for 7 consecutive days . Results Compared with placebo , tolvaptan administered for 7 days significantly reduced body weight and improved symptoms associated with volume overload . The safety profile of tolvaptan was considered acceptable for clinical use with minimal adverse effects . Conclusion Tolvaptan reduced volume overload and improved congestive symptoms associated with HF by a potent water diuresis ( aquaresis ) Hospitalization for worsening chronic heart failure results in high post-discharge mortality , morbidity , and cost . However , thorough characterization , soon after discharge of patients with early post-discharge events has not been previously performed . The objectives of this study were to describe the baseline , in-hospital , and post-discharge clinical , laboratory , and neurohormonal profiles of patients hospitalized for worsening heart failure with reduced ejection fraction ( EF ) who die or are re-admitted for cardiovascular ( CV ) causes within 90 days of initial hospitalization . Retrospective analysis of 4,133 patients hospitalized for worsening heart failure with EF ≤40 % in the Efficacy of Vasopressin Antagonism in Heart Failure : Outcome Study with Tolvaptan ( EVEREST ) trial , which r and omized patients to tolvaptan or placebo , both in addition to st and ard therapy . Clinical and laboratory parameters were obtained within 48 h of admission , during hospitalization , and post-discharge weeks 1 , 4 , 8 , and every 8 weeks thereafter for a median of 9.9 months . Patients with events within 90 days were compared with those with later/no events . All-cause mortality ( ACM ) and CV re-hospitalization were independently adjudicated . Within 90 days of admission , 395 patients ( 9.6 % ) died and 801 patients ( 19.4 % ) were re-hospitalized for CV causes . Significant baseline and longitudinal differences were seen between groups with early versus later ( > 90 days ) or no events at 12 months post-r and omization . Post-discharge outcomes were similar in the tolvaptan and placebo groups . Patients with early post-discharge events experienced clinical ly significant worsening in signs and symptoms , laboratory values , and neurohormonal parameters soon after discharge . Identifying these abnormalities may facilitate efforts to reduce post-discharge mortality and re-hospitalization BACKGROUND Heart failure ( HF ) is common in long-term care facilities ( LTCs ) . This study compared mortality and hospitalization rates and examined predictors of these outcomes among new LTC residents with and without HF . METHODS AND RESULTS This prospect i ve cohort study followed 546 newly admitted residents from 42 LTCs for up to 1 year . Health information was collected from participant and caregiver interviews , physicians ' records , diagnostic procedures , and hospitalization records . Multivariate logistic regression modeling determined predictors of hospitalization among residents , and Cox proportional hazards regression determined predictors for time to mortality . HF prevalence was 21.4 % . The sample was predominantly ( > 70 % ) female , and individuals with HF were significantly older with higher prevalence of reduced left ventricular ejection fraction . Overall annual mortality and hospitalization rates were 24 % and 27 % , respectively . Among residents with HF , 42 % died and 31 % were hospitalized within 1 year . Among residents with HF , use of major tranquilizers was the strongest predictor of sooner mortality ; use of anticoagulants and major tranquilizers also increased mortality risk , whereas higher baseline function was associated with longer time to mortality . History of peripheral vascular disease was the strongest predictor of hospitalizations among residents with HF , and use of antiplatelet agents and history of any smoking exposure increased this risk . CONCLUSIONS Among LTC residents , HF is associated with high mortality and hospitalization rates . Many factors contribute to mortality and hospitalizations among residents with HF , and comprehensive HF management programs are needed to improve outcomes BACKGROUND More efficacious and /or safer decongestive therapy is clearly needed in acute heart failure ( AHF ) patients complicated by renal dysfunction . We tested the hypothesis that adding tolvaptan , an oral vasopressin-2 receptor antagonist , to conventional therapy with loop diuretics would be more effective treatment in this population . METHODS AND RESULTS A multicenter , open-label , r and omized control trial was performed , and 217 AHF patients with renal dysfunction ( estimated glomerular filtration rate 15 - 60 mL • min(-1 ) • 1.73 m(-2 ) ) were r and omized 1:1 to treatment with tolvaptan ( n=108 ) or conventional treatment ( n=109 ) . The primary end point was 48-hour urine volume . The tolvaptan group showed more diuresis than the conventional treatment group ( 6464.4 vs 4999.2 mL ; P < .001 ) despite significantly lower amounts of loop diuretic use ( 80 mg vs 120 mg ; P < .001 ) . Dyspnea relief was achieved significantly more frequently in the tolvaptan group at all time points within 48 hours except 6 hours after enrollment . The rate of worsening of renal function ( ≥0.3 mg/dL increase from baseline ) was similar between the tolvaptan and conventional treatment groups ( 24.1 % vs 27.8 % , respectively ; P = .642 ) . CONCLUSIONS Adding tolvaptan to conventional treatment achieved more diuresis and relieved dyspnea symptoms in AHF patients with renal dysfunction . CLINICAL TRIAL REGISTRATION URL : http://www.umin.ac.jp/ctr/index/htm/ Unique identifier : UMIN000007109 Objectives To assess the efficacy of tolvaptan in acute heart failure with hyponatremia using a r and omized double-blinded placebo-controlled study design . Background Tolvaptan is a selective vasopressin receptor 2 antagonist . There are no published clinical trials on the utility of tolvaptan in acute heart failure with hyponatremia in the Indian population . Methods After screening and informed consent , 51 HF patients with hyponatremia were r and omized using computer-generated r and omization sequence to receive placebo or 15 mg of tolvaptan for 5 days along with conventional medical therapy . The patient 's perception of dyspnea using Likert score and the plasma sodium was measured at baseline and for the next 4 days . Results There was a mean improvement in sodium concentration by 5 mEq/L ( p = 0.001 ) in patients receiving tolvaptan , whereas no significant improvement was seen in the placebo group ( p = 0.33 ) . Significant improvement in Likert score was observed in both the groups ( p = 0.001 ) , even though there was no difference between both the groups . Dry mouth and thirst were the most commonly occurring adverse effects observed in both the groups . There were no significant hemodynamic changes with tolvaptan therapy . Conclusion Tolvaptan at a dose of 15 mg is effective in reversing hyponatremia in acute heart failure and may be a suitable option in these patients Background —In this study , we evaluated the effects of tolvaptan ( OPC-41061 ) , a novel , oral , nonpeptide vasopressin V2-receptor antagonist in patients with chronic heart failure ( CHF ) . Methods and Results —This was a double-blind study investigating the effects of three doses of tolvaptan and placebo in patients with CHF . After a run-in period , 254 patients were r and omly assigned to placebo ( n=63 ) or tolvaptan [ 30 mg ( n=64 ) , 
    Output:
    
Conclusion In older patients  , tolvaptan  relieves WRF , reduces the hospitalization period , and increases urine volume without significant effects on blood pressure .
However , surprisingly , the use of tolvaptan did not influence 6‑month all-cause mortality .
Signifikante Unterschiede zwischen den Gruppen best and en bei der Natriumkonzentration i m Serum ( MD : 0,68 ; 95%-KI : 0,02–1,34 ; p = 0,04 ) , aber nicht beim systolischen Blutdruck ( MD : 3,57 ; 95%-KI : −2,33 bis 9,47 ; p = 0,24).SchlussfolgerungBei älteren Patienten führt Tolvaptan zur Verminderung der WRF , zur Senkung der Hospitalisierungsdauer und zur Steigerung des Urinvolumens ohne signifikante Wirkung auf den Blutdruck .