{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T16:22:13Z","timestamp":1783009333583,"version":"3.54.5"},"reference-count":24,"publisher":"American Veterinary Medical Association (AVMA)","issue":"7","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ajvr"],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"sc_a1\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the safety and preliminary efficacy of substituting torsemide with tolvaptan on renal biomarkers in dogs with myxomatous mitral valve disease (MMVD) and concurrent azotemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sc_a2\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective observational study reviewed medical records of dogs with American College of Veterinary Internal Medicine stage C or D MMVD and azotemia. Three 60-day cohorts were analyzed: group 1, torsemide dose reduction (25% to 50%); group 2, 50% replacement of torsemide with tolvaptan; and group 3, complete replacement of torsemide with tolvaptan. Renal biomarkers (BUN, creatinine, and symmetric dimethylarginine [SDMA]) were evaluated at baseline, day 30, and day 60.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sc_a3\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>41 dogs were included. Groups 2 (50% torsemide replacement with tolvaptan) and 3 (complete replacement) showed significant reductions in BUN, creatinine, and SDMA at days 30 and 60 versus baseline. In group 2, mean creatinine decreased from 2.4 \u00b1 1.5 mg\/dL at baseline to 1.6 \u00b1 1.2 mg\/dL (day 30) and 1.7 \u00b1 1.0 mg\/dL (day 60), whereas SDMA decreased from 29.9 \u00b1 17.5 \u00b5g\/dL to 21.5 \u00b1 5.7 \u00b5g\/dL and 23.6 \u00b1 11.1 \u00b5g\/dL, respectively. No significant changes occurred in group 1 (torsemide reduction). Sodium increased modestly in the tolvaptan groups, potassium remained within reference ranges, and echocardiographic and hepatic parameters remained stable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sc_a4\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Substituting torsemide with tolvaptan was associated with significant improvement in renal biomarkers in dogs with MMVD and azotemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sc_a5\">\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>These findings suggest that tolvaptan substitution may represent a potential therapeutic option for managing azotemia in dogs with congestive heart failure receiving loop diuretics, although prospective controlled studies are needed to confirm clinical benefit.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2460\/ajvr.25.11.0407","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T12:35:02Z","timestamp":1776861302000},"source":"Crossref","is-referenced-by-count":0,"title":["Tolvaptan substitution for torsemide is associated with improved renal biomarkers in dogs with advanced myxomatous mitral valve disease and concurrent azotemia"],"prefix":"10.2460","volume":"87","author":[{"given":"Sung-Soo","family":"Park","sequence":"first","affiliation":[{"name":"Animal Heart Institute, VIP Animal Medical Center, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4398-0371","authenticated-orcid":true,"given":"Jiyoung","family":"Park","sequence":"additional","affiliation":[{"name":"Animal Heart Institute, VIP Animal Medical Center, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6434-6930","authenticated-orcid":true,"given":"Changbaig","family":"Hyun","sequence":"additional","affiliation":[{"name":"Animal Heart Institute, VIP Animal Medical Center, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1272","reference":[{"issue":"5","key":"B1","series-title":"Vet Clin North Am Small Anim Pract","first-page":"1083","article-title":"Cardiorenal syndrome: diagnosis and management","author":"Orvalho JS","year":"2017","unstructured":"Orvalho JS, Cowgill LD. Cardiorenal syndrome: diagnosis and management. Vet Clin North Am Small Anim Pract. 2017;47(5):1083\u20131102. doi:10.1016\/j.cvsm.2017.05.004"},{"issue":"9","key":"B2","series-title":"J Small Anim Pract","first-page":"537","article-title":"Cardiovascular-renal axis disorders in the domestic dog and cat: a veterinary consensus statement","author":"Pouchelon JL","year":"2015","unstructured":"Pouchelon JL, Atkins CE, Bussadori C, et al. Cardiovascular-renal axis disorders in the domestic dog and cat: a veterinary consensus statement. J Small Anim Pract. 2015;56(9):537\u2013552. doi:10.1111\/jsap.12387"},{"issue":"1","key":"B3","series-title":"Cardiovasc Drug Rev","first-page":"1","article-title":"Tolvaptan, an orally active vasopressin V2-receptor antagonist - pharmacology and clinical trials","author":"Miyazaki T","year":"2007","unstructured":"Miyazaki T, Fujiki H, Yamamura Y, Nakamura S, Mori T. Tolvaptan, an orally active vasopressin V2-receptor antagonist - pharmacology and clinical trials. Cardiovasc Drug Rev. 2007;25(1):1\u201313. doi:10.1111\/j.1527-3466.2007.00001.x"},{"issue":"10","key":"B4","series-title":"Expert Rev Cardiovasc Ther","first-page":"1331","article-title":"EVEREST study: efficacy of vasopressin antagonism in heart failure outcome study with tolvaptan","author":"Cavalcante JL","year":"2008","unstructured":"Cavalcante JL, Khan S, Gheorghiade M. EVEREST study: efficacy of vasopressin antagonism in heart failure outcome study with tolvaptan. Expert Rev Cardiovasc Ther. 2008;6(10):1331\u20131338. doi:10.1586\/14779072.6.10.1331"},{"issue":"4","key":"B5","series-title":"Pharmacotherapy","first-page":"473","article-title":"Tolvaptan for volume management in heart failure","author":"Gunderson EG","year":"2019","unstructured":"Gunderson EG, Lillyblad MP, Fine M, Vardeny O, Berei TJ. Tolvaptan for volume management in heart failure. 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