The Rational Use of Diuretics in the Management of Cirrhotic Ascites in Japan

Abstract

In cirrhosis, portal hypertension and hypoalbuminemia due to decreased albumin synthetic capacity and hormonal imbalance due to increased renin-angiotensin-aldosterone and vasopressin systems cause fluid retention and electrolyte abnormalities. Diuretics are indispensable for the control of body fluid volume in liver cirrhosis, and aldosterone antagonists and loop diuretics have been widely used until now. In Japan, tolvaptan, a vasopressin V2 receptor antagonists, became available in September 2013, expanding treatment options. This drug has been reported to be effective in improving hyponatremia and ascites in combination with aldosterone antagonists and loop diuretics without markedly affecting renal function. Excessive diuretic use should be avoided because it can cause deterioration of the renal function, which influences the vital prognosis of liver cirrhosis. Therefore, it is important to choose the appropriate diuretics to protect of the renal function.