Tolvaptan-Induced Polyuria Management

Clinical Implications

• The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend that patients drink enough water to replace urinary losses to ensure long-term tolerability, and low osmolar intake reduces polyuria, with patients counseled to drink liquids without sugar or fat and adopt a low-sodium intake 1
• The KDIGO guidelines also emphasize that tolvaptan treatment should be interrupted in situations causing volume depletion or inability to compensate for aquaresis, and patients need a "sick-day plan" to skip doses during situations with limited water access, increased fluid losses, or activities in warm weather 1