title: The treatment of vasopressin V2-receptor antagonists in cirrhosis patients with ascites: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Ascites is the most common complication of cirrhosis. It may lead to the consequence of poor prognosis and the deterioration of quality of life. Asopressin V2 receptor antagonists is a kind of vaptans, and it has been proved to be effective in hyponatremia patients. We conducted a meta-analysis about treatment of vaptans in cirrhosis patients with ascites.
  
  
  METHODS
  Following our selection criteria, we collected a total of 14 studies containing 16 randomized controlled trials (2620 patients) from a series of database about the treatment with vaptans for cirrhosis with ascites patients. The included studies compared the treatment effect of lixivaptan (VPA 985), or RMJ-351647, or satavaptan, or tolvaptan with placebo.
  
  
  RESULTS
  The included vaptans (asopressin V2 receptor antagonists) showed significant effect of increasing the serum sodium concentration for cirrhosis patients (WMD = 2.11 mmol/L, p < 0.00001). Patients also could acquire significant improvement of ascites, as this kind of aquaretics can significantly reduce ascites patients' weight (WMD = -1.53, p < 0.00001), abdominal girth (WMD = -2.04, p < 0.00001), and the ratio of worsening ascites (RR = 0.51, p = 0.001). Though the drug did not produce more total adverse events (RR = 1.04, p = 0.09) and the total serious events (RR = 1.04, p = 0.42), the emergence of excessive correction of serum sodium concentrations (>145 mmol/L) was more frequently noted in patients under the employment of vaptans (RR = 2.14, 95 % CI [1.45, 3.16], p = 0.0001). Whether with the administration of vaptans for short-term or long-term, no survival benefit was detected from the selected studies.
  
  
  CONCLUSIONS
  Asopressin V2 receptor antagonists could play an effective and safe role in symptomatic treatment for cirrhosis patients with ascites, especially for refractory ascites patients who presented insufficient response to conventional diuretics.
authors.affiliation: Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, 200438, China. yanlong165@hotmail.com.
authors.forename: Long
authors.initials: L
authors.lastname: Yan
authors.affiliation: Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, 200438, China. hunanxiefeng@aliyun.com.
authors.forename: Feng
authors.initials: F
authors.lastname: Xie
authors.affiliation: Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, 200438, China. tyxyr_0407@163.com.
authors.forename: Jiongjiong
authors.initials: J
authors.lastname: Lu
authors.affiliation: Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, 200438, China. 31796891@qq.com.
authors.forename: Qingqiang
authors.initials: Q
authors.lastname: Ni
authors.affiliation: Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, 200438, China. 2417067217@qq.com.
authors.forename: Changying
authors.initials: C
authors.lastname: Shi
authors.affiliation: Hepatobiliary and pancreatic surgery center, Zhuzhou Central Hospital, Zhuzhou, 412007, China. 2785133503@qq.com.
authors.forename: Caixi
authors.initials: C
authors.lastname: Tang
authors.affiliation: Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, 200438, China. 13386272885@189.cn.
authors.forename: Jiamei
authors.initials: J
authors.lastname: Yang
mesh_terms: D065092:Antidiuretic Hormone Receptor Antagonists / Q000627:therapeutic use*; D001201:Ascites / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists