Abstract
BackgroundThe vasopressin V2-receptor antagonist tolvaptan is used to treat cirrhotic patients with ascites. We investigated the outcome of long-term treatment.MethodsThis was a single-center retrospective study. Overall, 170 cirrhotic patients (95 males, median age 63 years) were enrolled and received tolvaptan orally after hospitalization for ascites, which included treatment with conventional diuretics. We compared patients who withdrew tolvaptan treatment after < 1 year (n = 90) with patients who continued treatment for ≥1 year (n = 37). In continuously treated patients, the pretreatment and post-treatment (1 year) blood biochemistry values were assessed.ResultsOverall, 37 patients received treatment for ≥1 year and showed a higher response after tolvaptan therapy. The reduction in body weight was 2.0 (− 3.4–17.2) kg compared to discontinued cases, which had a body weight reduction of 1.1 (− 6.2–7.5) kg after 1 week. The group that received treatment for ≥1 year had a significantly lower rate of the complication gastroesophageal varices and also showed better liver function. In patients with continued treatment, serum levels of albumin was significantly higher without renal disturbance after 1 year of treatment. The prothrombin time/international normalized ratio and ammonia level were also significantly improved. Multivariate analyses showed that a change in body weight reduction and serum levels of albumin were predictive factors of continued administration.ConclusionsLong-term tolvaptan treatment increased serum levels of albumin, decreased ammonia levels, and preserved renal function after 1 year of treatment. A reduction in body weight after 1 week was associated with a favorable outcome of tolvaptan therapy.
Highlights
The vasopressin V2-receptor antagonist tolvaptan is used to treat cirrhotic patients with ascites
Liver cirrhosis occurs in end-stage liver disease, and ascites accumulation is a sign of decompensated liver cirrhosis
Tolvaptan was started from a half dose (3.75 mg once per day) and it was increased to 7.5 mg/day if the response or body weight reduction was insufficient
Summary
The vasopressin V2-receptor antagonist tolvaptan is used to treat cirrhotic patients with ascites. Following the development of ascites, the 5-year survival rate is only 50% [1, 2]. After the development of dilutional hyponatremia, refractory ascites, and type 2 hepatorenal syndrome, the 1-year probability of survival is 25.6, 31.6, and 38.5%, respectively [2]. Ascites treatment for liver cirrhosis patients is important, and the vasopressin V2-receptor antagonist tolvaptan has dramatically improved this treatment [3, 4]. We have shown that treatment with tolvaptan for 6 months is efficacious and safe and may improve the prognosis of cirrhotic patients [6, 7]. Median survival is significantly longer in patients with less ascites accompanying diuretic treatment [8]. According to a meta-analysis of randomized controlled trials, a tolvaptan-associated reduction in diuretic use is associated with lower serum sodium levels and maintenance of renal
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