title: Clinical efficacy of tolvaptan for treatment of refractory ascites in liver cirrhosis patients.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of tolvaptan to treat refractory ascites in decompensated liver cirrhosis patients with or without further complications, such as hepatorenal syndrome and/or hepatocellular carcinoma.
  
  
  METHODS
  Thirty-nine patients (mean age 55 years, males: 32) with decompensated liver cirrhosis and refractory ascites were enrolled. All patients received a combination of tolvaptan (15 mg/d for 5-14 d) and diuretics (40-80 mg/d of furosemide and 80-160 mg/d of spironolactone). The etiology of cirrhosis included hepatitis B (69.2%), hepatitis C (7.7%) and alcohol-induced (23.1%). Changes in the urine excretion volume, abdominal circumference and edema were assessed. The serum sodium levels were also measured, and adverse events were recorded. A follow-up assessment was conducted 1 mo after treatment with tolvaptan.
  
  
  RESULTS
  Tolvaptan increased the mean urine excretion volume (1969.2 ± 355.55 mL vs 3410.3 ± 974.1 mL, P < 0.001), and 89.7% of patients showed improvements in their ascites, 46.2% of whom showed significant improvements. The overall efficacy of tolvaptan in all patients was 89.7%; the efficacies in patients with hepatocellular carcinoma and hepatorenal syndrome were 84.2% and 77.8%, respectively. The incidence of hyponatremia was 53.8%. In patients with hyponatremia, the serum sodium levels increased after tolvaptan treatment (from 128.1 ± 4.22 mEq/L vs 133.1 ± 3.8 mEq/L, P < 0.001). Only mild drug-related adverse events, including thirst and dry mouth, were observed.
  
  
  CONCLUSIONS
  Tolvaptan is a promising aquaretic for the treatment of refractory ascites in patients with decompensated liver cirrhosis.
authors.affiliation: Xin Zhang, Shu-Zhen Wang, Jun-Fu Zheng, Wen-Min Zhao, Peng Li, Chun-Lei Fan, Bing Li, Pei-Ling Dong, Lei Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Xin Zhang, Shu-Zhen Wang, Jun-Fu Zheng, Wen-Min Zhao, Peng Li, Chun-Lei Fan, Bing Li, Pei-Ling Dong, Lei Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: Shu-Zhen
authors.initials: SZ
authors.lastname: Wang
authors.affiliation: Xin Zhang, Shu-Zhen Wang, Jun-Fu Zheng, Wen-Min Zhao, Peng Li, Chun-Lei Fan, Bing Li, Pei-Ling Dong, Lei Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: Jun-Fu
authors.initials: JF
authors.lastname: Zheng
authors.affiliation: Xin Zhang, Shu-Zhen Wang, Jun-Fu Zheng, Wen-Min Zhao, Peng Li, Chun-Lei Fan, Bing Li, Pei-Ling Dong, Lei Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: Wen-Min
authors.initials: WM
authors.lastname: Zhao
authors.affiliation: Xin Zhang, Shu-Zhen Wang, Jun-Fu Zheng, Wen-Min Zhao, Peng Li, Chun-Lei Fan, Bing Li, Pei-Ling Dong, Lei Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Li
authors.affiliation: Xin Zhang, Shu-Zhen Wang, Jun-Fu Zheng, Wen-Min Zhao, Peng Li, Chun-Lei Fan, Bing Li, Pei-Ling Dong, Lei Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: Chun-Lei
authors.initials: CL
authors.lastname: Fan
authors.affiliation: Xin Zhang, Shu-Zhen Wang, Jun-Fu Zheng, Wen-Min Zhao, Peng Li, Chun-Lei Fan, Bing Li, Pei-Ling Dong, Lei Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Li
authors.affiliation: Xin Zhang, Shu-Zhen Wang, Jun-Fu Zheng, Wen-Min Zhao, Peng Li, Chun-Lei Fan, Bing Li, Pei-Ling Dong, Lei Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: Pei-Ling
authors.initials: PL
authors.lastname: Dong
authors.affiliation: Xin Zhang, Shu-Zhen Wang, Jun-Fu Zheng, Wen-Min Zhao, Peng Li, Chun-Lei Fan, Bing Li, Pei-Ling Dong, Lei Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Li
authors.affiliation: Xin Zhang, Shu-Zhen Wang, Jun-Fu Zheng, Wen-Min Zhao, Peng Li, Chun-Lei Fan, Bing Li, Pei-Ling Dong, Lei Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: Hui-Guo
authors.initials: HG
authors.lastname: Ding
mesh_terms: D065092:Antidiuretic Hormone Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D001201:Ascites / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D001552:Benzazepines / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D004487:Edema / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012964:Sodium / Q000097:blood; D013997:Time Factors; D000077602:Tolvaptan; D016896:Treatment Outcome; D014554:Urination / Q000187:drug effects; D014563:Urodynamics / Q000187:drug effects
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D015415:Biomarkers; D000077602:Tolvaptan; D012964:Sodium
keywords: Decompensation; Hyponatremia; Liver cirrhosis; Refractory ascites; Tolvaptan