Abstract 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 randomized 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 24 h 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.
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