{
    "abstract": "Globally, cardiovascular diseases remain a predominant cause of mortality. Effective fluid management is particularly critical in older adults undergoing cardiac surgery, due to their heightened risk of postoperative complications. Tolvaptan, an oral vasopressin V2 receptor antagonist, has emerged as a promising agent for fluid regulation in cardiac patients. However, its efficacy in the elderly undergoing cardiac surgery is not thoroughly evaluated.\nThis single-center retrospective analysis included 146 older adults (\u2265 65 years) who underwent cardiac surgery between January 2018 and December 2022. Patients were categorized into two groups: those receiving tolvaptan and a control group receiving traditional diuretics post-surgery. We assessed several outcomes, including hospital length of stay, 30-day mortality, postoperative renal function, and complications.\nThe study found a significantly reduced hospitalization duration in the tolvaptan group (P=0.044), with no escalation in adverse events. The tolvaptan cohort exhibited a considerable increase in urine output on the postoperative day (POD) three (P=0.003), indicating enhanced renal function and fluid management. Serum creatinine levels notably declined by POD3 (P=0.012), and blood urea nitrogen levels were appreciably lower by POD5 (P<0.001) in the tolvaptan group. Furthermore, serum sodium levels significantly escalated on POD3 and POD5 (P<0.01) in this group, while serum potassium levels remained unchanged.\nTolvaptan significantly optimizes postoperative fluid management in older adults undergoing cardiac surgery. Its administration is linked to improved renal function and a shortened hospital stay, without amplifying adverse effects. These insights could enhance clinical practices and facilitate the management of fluid overload in this vulnerable demographic.",
    "authors": [
        {
            "affiliation": "Department of Cardiothoracic Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, People's Republic of China.",
            "firstname": "Lin",
            "initials": "L",
            "lastname": "Chen"
        },
        {
            "affiliation": "Department of Cardiothoracic Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, People's Republic of China.",
            "firstname": "Min",
            "initials": "M",
            "lastname": "Zhou"
        },
        {
            "affiliation": "Department of Cardiothoracic Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, People's Republic of China.",
            "firstname": "Dingliang",
            "initials": "D",
            "lastname": "Lv"
        },
        {
            "affiliation": "Department of Cardiothoracic Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, People's Republic of China.\nDepartment of Cardiothoracic Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, People's Republic of China.",
            "firstname": "Shuiwei",
            "initials": "S",
            "lastname": "Qiu"
        }
    ],
    "conclusions": "Tolvaptan significantly optimizes postoperative fluid management in older adults undergoing cardiac surgery. Its administration is linked to improved renal function and a shortened hospital stay, without amplifying adverse effects. These insights could enhance clinical practices and facilitate the management of fluid overload in this vulnerable demographic.",
    "copyrights": null,
    "doi": "10.21470/1678-9741-2023-0507\n10.1016/j.pcad.2022.08.005.\n10.1186/s12889-021-11348-w.\n10.3390/nu13103419.\n10.1093/jn/nxab037.\n10.1186/s13063-021-05992-1.\n10.1517/14656566.3.5.505.\n10.1097/ALN.0000000000001434.\n10.1186/1749-8090-5-17.\n10.1111/joim.12645.\n10.1056/NEJMoa065181.\n10.1532/hsf.1470.\n10.15420/ecr.2021.16.PO11.\n10.1097/ACO.0000000000000055.\n10.5507/bp.2023.038.\n10.1159/000455061.\n10.1159/000490500.\n10.1210/endrev/bnad010.\n10.1053/j.jvca.2004.05.021.\n10.3390/biomedicines11092364.\n10.1007/s00595-016-1406-5.\n10.5761/atcs.oa.20-00364.\n10.1016/j.nefroe.2023.04.002.\n10.1007/s12325-021-01947-9.\n10.1111/j.1524-6175.2002.01728.x.",
    "journal": "Brazilian journal of cardiovascular surgery",
    "keywords": [
        "Aged",
        "Cardiac Surgical Procedures",
        "Diuretics",
        "Kidney",
        "Length of Stay",
        "Potassium",
        "Sodium",
        "Tolvaptan"
    ],
    "methods": null,
    "publication_date": "2024-11-28",
    "pubmed_id": "39607973\n35961405\n34187450\n34684419\n33831953\n19346639\n35101083\n11996629\n27841822\n20346182\n28649750\n22730868\n20715712\n17105757\n26726710\n35106083\n24514030\n37799003\n28142133\n29945154\n36974717\n15365924\n37760806\n27553014\n34053960\n37150675\n3317287\n34693505\n12045369",
    "results": "The study found a significantly reduced hospitalization duration in the tolvaptan group (P=0.044), with no escalation in adverse events. The tolvaptan cohort exhibited a considerable increase in urine output on the postoperative day (POD) three (P=0.003), indicating enhanced renal function and fluid management. Serum creatinine levels notably declined by POD3 (P=0.012), and blood urea nitrogen levels were appreciably lower by POD5 (P<0.001) in the tolvaptan group. Furthermore, serum sodium levels significantly escalated on POD3 and POD5 (P<0.01) in this group, while serum potassium levels remained unchanged.",
    "title": "Efficacy of Tolvaptan in Older Adults Undergoing Cardiac Surgery: A Single-Center Retrospective Analysis.",
    "xml": "<Element 'PubmedArticle' at 0x78850667c7c0>"
}