The Outcome of Cirrhotic Patients with Ascites Is Improved by the Normalization of the Serum Sodium Level by Tolvaptan

Overview

Journal Intern Med

Specialty General Medicine

Date 2017 Sep 26

PMID 28943585

Citations 5

Authors

Tomomi Kogiso

Mutsuki Kobayashi

Kuniko Yamamoto

Yuichi Ikarashi

Kazuhisa Kodama

Makiko Taniai

Nobuyuki Torii

Etsuko Hashimoto

Katsutoshi Tokushige

Affiliations

Soon will be listed here.

Abstract

Objective Hyponatremia is frequently observed in patients with decompensated liver cirrhosis and it is also related to a poor prognosis. The vasopressin V2-receptor antagonist tolvaptan is used to treat cirrhotic patients with ascites and increases the serum sodium (Na) level. In this study, we investigated (i) whether or not correction of the Na level improves the prognosis of cirrhotic patients with ascites and (ii) predictors of normalization of the serum Na level after tolvaptan therapy. Methods This was a single-center retrospective study. A total of 95 Japanese cirrhotic patients (60 men, median age 63 years) were enrolled and received tolvaptan orally after hospitalization for ascites treatment. The serum Na level was monitored during the period of tolvaptan treatment. The laboratory data and survival rates of patients who achieved serum Na levels of <135 and ≥135 mEq/L after 1 week were compared. Results Patients showed serum Na levels of 136 (121-145) mEq/L, and 42.1% had a serum Na level of <135 mEq/L. Among patients with an initial serum Na level <135 mEq/L, 60.0% achieved a normal level after 1 week, and the survival rate was significantly higher in patients with a normalized serum Na level (p<0.01). The pretreatment brain natriuretic peptide (BNP) level was predictive of achieving a serum Na level of ≥135 mEq/L (odds ratio: 0.87, 95% confidence interval: 0.316-0.987, p<0.05). Conclusion Normalization of the Na level after one week was associated with a favorable outcome of tolvaptan therapy, and Na correction improved the prognosis.

Citing Articles

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Different Effects on Fluid Distribution between Tolvaptan and Furosemide in a Liver Cirrhosis Patient with Chronic Kidney Disease.

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Impact of continued administration of tolvaptan on cirrhotic patients with ascites.

Kogiso T, Sagawa T, Kodama K, Taniai M, Tokushige K BMC Pharmacol Toxicol. 2018; 19(1):87.

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Tolvaptan treatment improves survival of cirrhotic patients with ascites and hyponatremia.

Wang S, Zhang X, Han T, Xie W, Li Y, Ma H BMC Gastroenterol. 2018; 18(1):137.

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Association between the Serum Sodium Levels and the Response to Tolvaptan in Liver Cirrhosis Patients with Ascites and Hyponatremia.

Hayashi M, Abe K, Fujita M, Okai K, Takahashi A, Ohira H Intern Med. 2018; 57(17):2451-2458.

PMID: 29607963 PMC: 6172543. DOI: 10.2169/internalmedicine.0629-17.

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