Clinical implications with tolvaptan on monitored bioimpedance-defined fluid status in patients with cirrhotic ascites: an observational study
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 ci...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-03-01
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| Series: | BMC Gastroenterology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12876-020-01205-2 |
| _version_ | 1818408700736438272 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Shunsuke Shiba |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-14T09:47:54Z |
| format | Article |
| id | doaj.art-2792815d456e46feac8df17bd856af1d |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-14T09:47:54Z |
| publishDate | 2020-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-2792815d456e46feac8df17bd856af1d2022-12-21T23:07:35ZengBMCBMC Gastroenterology1471-230X2020-03-0120111410.1186/s12876-020-01205-2Clinical implications with tolvaptan on monitored bioimpedance-defined fluid status in patients with cirrhotic ascites: an observational studyShunsuke Shiba0Po-sung Chu1Nobuhiro Nakamoto2Karin Yamataka3Nobuhito Taniki4Keisuke Ojiro5Akihiro Yamaguchi6Rei Morikawa7Aya Yoshida8Akihiko Ikura9Hirotoshi Ebinuma10Hidetsugu Saito11Takanori Kanai12Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of MedicineDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of MedicineDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of MedicineDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of MedicineDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of MedicineDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of MedicineDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of MedicineDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of MedicineDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of MedicineDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of MedicineDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of MedicineDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of MedicineDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of MedicineAbstract 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.http://link.springer.com/article/10.1186/s12876-020-01205-2AscitesImpedanceLiver cirrhosisVasopressin antagonism |
| spellingShingle | 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 Clinical implications with tolvaptan on monitored bioimpedance-defined fluid status in patients with cirrhotic ascites: an observational study BMC Gastroenterology Ascites Impedance Liver cirrhosis Vasopressin antagonism |
| title | Clinical implications with tolvaptan on monitored bioimpedance-defined fluid status in patients with cirrhotic ascites: an observational study |
| title_full | Clinical implications with tolvaptan on monitored bioimpedance-defined fluid status in patients with cirrhotic ascites: an observational study |
| title_fullStr | Clinical implications with tolvaptan on monitored bioimpedance-defined fluid status in patients with cirrhotic ascites: an observational study |
| title_full_unstemmed | Clinical implications with tolvaptan on monitored bioimpedance-defined fluid status in patients with cirrhotic ascites: an observational study |
| title_short | Clinical implications with tolvaptan on monitored bioimpedance-defined fluid status in patients with cirrhotic ascites: an observational study |
| title_sort | clinical implications with tolvaptan on monitored bioimpedance defined fluid status in patients with cirrhotic ascites an observational study |
| topic | Ascites Impedance Liver cirrhosis Vasopressin antagonism |
| url | http://link.springer.com/article/10.1186/s12876-020-01205-2 |
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