Abstract
We investigated sarcopenia, focusing on the dose of loop diuretics used in 70 patients with refractory hepatic ascites treated with tolvaptan. Bloating improved in 68.5% of patients, as determined using the Japanese version of the Support Team Assessment Schedule. The psoas muscle index (PMI) was used to define sarcopenia. A statistically significant difference was observed in the PMI between patients receiving low-dose (3.6 ± 1.2 cm2/m2) and high-dose furosemide (3.1 ± 1.2 cm2/m2) before tolvaptan treatment (P = 0.048). The PMI increased from 3.2 ± 1.1 cm2/m2 to 3.5 ± 1.3 cm2/m2 (P = 0.002) in responders, but decreased from 3.4 ± 1.2 cm2/m2 to 3.0 ± 1.0 cm2/m2 (P = 0.106) in non-responders before and after tolvaptan treatment, respectively. The long-term prognosis improved in responders compared with non-responders (mean survival time: 646 days vs. 228 days, P < 0.001). Early introduction of tolvaptan treatment is necessary to prevent the progression of sarcopenia.
Highlights
Refractory hepatic ascites that cannot be controlled with conventional therapy by using loop diuretics and spironolactone greatly reduces a patient’s general status and quality of life [1]
We investigated sarcopenia, focusing on the dose of loop diuretics used in 70 patients with refractory hepatic ascites treated with tolvaptan
Bloatedness improved in 68.5% of patients with refractory hepatic ascites after tolvaptan treatment based on the STAS-J score, pain was relieved, and nutritional status improved, as shown by caloric intake
Summary
Refractory hepatic ascites that cannot be controlled with conventional therapy by using loop diuretics and spironolactone greatly reduces a patient’s general status and quality of life [1]. Tolvaptan was recently approved in Japan for refractory hepatic ascites that demonstrates an insufficient response to loop diuretics. Muscular enlargement occurred with exercise in a normal mouse, but muscular hypertrophy could not develop in a mouse receiving a loop diuretic. These results suggested that the frequency of sarcopenia may increase in patients receiving a high-dose loop diuretic. Whether sarcopenia is associated with the dose of loop diuretics in patients with refractory hepatic ascites treated with tolvaptan remains unclear. We evaluated the association between loop diuretic dose and sarcopenia in refractory hepatic ascites treated with tolvaptan
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