Abstract
A 77-year-old woman was admitted to our hospital because of exacerbation of cardio-renal failure, hyperkalemia, and third-degree atrioventricular block. The patient had been suffering from chronic heart failure due to ischemic cardiomyopathy, nephrosclerosis, and chronic pulmonary abscess, and was started on chronic hemodialysis therapy twice a week. However, her urine volume decreased to less than 300 mL per day, a year after starting hemodialysis. We subsequently administered tolvaptan at 15 mg in addition to furosemide and indapamide. This resulted in a remarkable increase in urine volume to more than 1 L per day. The increase of body weight between hemodialysis treatments was less than 1 kg, and her blood pressure and performance status were improved. This effect on water diuresis has been continuing for more than 2 years. The combined therapy of sodium diuretics and tolvaptan may be effective in patients with CKDG5A3-associated chronic heart failure, resulting in the production of sufficient amounts of urine, and in patients continuing hemodialysis therapy twice a week.
