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BMC Gastroenterology
Published in: BMC Gastroenterology 1/2020

Open Access 01-12-2020 | Diuretics | Research article

Clinical implications with tolvaptan on monitored bioimpedance-defined fluid status in patients with cirrhotic ascites: an observational study

Authors: Shunsuke Shiba, Po-sung Chu, Nobuhiro Nakamoto, Karin Yamataka, Nobuhito Taniki, Keisuke Ojiro, Akihiro Yamaguchi, Rei Morikawa, Aya Yoshida, Akihiko Ikura, Hirotoshi Ebinuma, Hidetsugu Saito, Takanori Kanai

Published in: BMC Gastroenterology | Issue 1/2020

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Abstract

Background

Prognostic value or clinical implications of fluid status monitoring in liver cirrhosis are not fully elucidated. Tolvaptan, an orally available, selective vasopressin V2-receptor antagonist approved for hyponatremia in the United States and European Union. It is also used for cirrhotic ascites at a relatively low dose (3.75 mg to 7.5 mg) in Japan, exerts its diuretic function by excreting electrolyte-free water. We hypothesized that bioimpedance-defined dynamic changes in fluid status allow prediction of response of V2 antagonism and survival in cirrhotic patients.

Methods

In this prospective observational study, 30 patients with decompensated liver cirrhosis who were unresponsive to conventional diuretics were enrolled. Detailed serial changes of body composition that were assessed by using non-invasive bioimpedance analysis (BIA) devices, along with biochemical studies, were monitored at 5 time points.

Results

Sixteen patients were classified as short-term responders (53%). Rapid and early decrease of BIA-defined intracellular water, as soon as 6 h after the first dose (ΔICWBIA%-6 h), significantly discriminated responders from non-responders (AUC = 0.97, P < 0.0001). ΔICWBIA%-6 h was highly correlated with the change of BIA-derived phase angle of trunk, e.g. reduced body reactance operated at 50 kHz after 24 h of the first dose of tolvaptan. Lower baseline blood urea nitrogen and lower serum aldosterone were predictive of a rapid and early decrease of ICWBIA. A rapid and early decrease of ICWBIA in response to tolvaptan was also predictive of a better transplant-free survival.

Conclusions

BIA-defined water compartment monitoring may help predict short-term efficacy and survival in decompensated cirrhotic patients treated with tolvaptan.
Appendix
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Metadata
Title
Clinical implications with tolvaptan on monitored bioimpedance-defined fluid status in patients with cirrhotic ascites: an observational study
Authors
Shunsuke Shiba
Po-sung Chu
Nobuhiro Nakamoto
Karin Yamataka
Nobuhito Taniki
Keisuke Ojiro
Akihiro Yamaguchi
Rei Morikawa
Aya Yoshida
Akihiko Ikura
Hirotoshi Ebinuma
Hidetsugu Saito
Takanori Kanai
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Gastroenterology / Issue 1/2020
Electronic ISSN: 1471-230X
DOI
https://doi.org/10.1186/s12876-020-01205-2

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