Abstract
Tolvaptan is a recently available diuretic that blocks arginine vasopressin receptor 2 in the renal collecting duct. Its diuretic mechanism involves selective water reabsorption by affecting the water reabsorption receptor aquaporin 2. Given that liver cirrhosis patients exhibit hyponatremia due to their pseudo-aldosteronism and usage of natriuretic agents, a sodium maintaining agent, such as tolvaptan, is physiologically preferable. However, large scale studies indicating the patients for whom this would be effective and describing management under its use have been insufficient. The appropriate management of cirrhosis patients treated with tolvaptan should be investigated. In the present review, we collected articles investigating the effectiveness of tolvaptan and factors associated with survival and summarized their management reports. Earlier administration of tolvaptan before increasing the doses of natriuretic agents is recommended because this may preserve effective arterial blood volume.
Highlights
C virus (HCV) direct anti-viral agents (DAAs), the incidence of alcohol-related and nonalcoholic steatohepatitis (NASH)-related cirrhosis is increasing [1]
We found articles investigating the effect of tolvaptan in cirrhotic ascites via Pubmed, using these search terms: ‘cirrhosis x tolvaptan’, ‘cirrhosis ascites tolvaptan’, and ‘cirrhosis x hyponatremia x tolvaptan’
In Section 4.2.2, we nisms of action, and discussed how to manage cirrhotic ascites under add-on administrasummarized the articles we found and our findings concerning the mechanisms of action, tion of tolvaptan
Summary
Liver cirrhosis and related complications are still regarded as unresolved issues. the prevalence of hepatitis C has decreased with the development of anti-hepatitis. Spironolactone is the first diuretic used for the management of cirrhotic ascites, followed by furosemide. Both agents block sodium reabsorption; hyponatremia and a reduction of effective arterial blood volume (EABV) commonly occur as side effects [3]. Terlipressin, an AVP analog with a high affinity for vasopressin-1 (V1) receptors, has been shown to be effective via dilated splanchnic vascular vasoconstriction [4]. Another agent that acts on AVP is tolvaptan, which is a highly selective AVP V2 receptor antagonist [5].
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