Author + information
- Basma Abdulhadi, MD∗ (, )
- Kenechukwu Mezue, MD, MSc and
- Janani Rangaswami, MD
- ↵∗Department of Medicine, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, Pennsylvania 19141
We read the recent paper by Konstam et al. (1) with great interest. In their randomized, placebo-controlled double-blinded study of 250 patients, of whom 122 received tolvaptan, they concluded that the addition of tolvaptan in the setting of acute heart failure in patients with hyponatremia, renal dysfunction, or diuretic resistance made no difference in dyspnea reduction as compared with patients receiving placebo, despite their finding that those who received tolvaptan had greater weight reduction.
The study cohort had a high prevalence of chronic kidney disease, where dyspnea is usually complex and multifactorial. Factors such as anemia of chronic disease, higher prevalence of pulmonary hypertension (2), as well as silent coronary artery disease in patients with chronic kidney disease may be confounding the evaluation of dyspnea as a primary outcome in this patient population. In support of our argument, we present the findings of Shlipak et al. (3) who concluded that patients with chronic kidney disease without a diagnosis of heart failure had symptoms characteristic of heart failure, including dyspnea, and that this was more evident in patients with lower estimated glomerular filtration rate and hemoglobin. Therefore, it would be interesting to assess whether patients with normal kidney function would respond differently to tolvaptan and have more significant reduction in dyspnea when kidney dysfunction is eliminated as a potential contributor to dyspnea.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Deepak L. Bhatt, MD, MPH, served as Guest Editor-in-Chief for this paper. Randall Starling, MD, served as Guest Editor for this paper.
- 2017 American College of Cardiology Foundation
- Konstam M.A.,
- Kiernan M.,
- Chandler A.,
- et al.,
- for the SECRET of CHF Investigators, Coordinators, and Committee Members
- Reque J.,
- Garcia-Prieto A.,
- Linares T.,
- et al.