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- Title
Analysis of factors predicting the response to tolvaptan in patients with liver cirrhosis and hepatic edema.
- Authors
Atsukawa, Masanori; Tsubota, Akihito; Kato, Keizo; Abe, Hiroshi; Shimada, Noritomo; Asano, Toru; Ikegami, Tadashi; Koeda, Mai; Okubo, Tomomi; Arai, Taeang; Nakagawa‐Iwashita, Ai; Yoshida, Yuji; Hayama, Korenobu; Itokawa, Norio; Kondo, Chisa; Chuganji, Yoshimichi; Matsuzaki, Yasushi; Iwakiri, Katsuhiko
- Abstract
Background and Aim: This study aimed to clarify the factors predictive of treatment response to tolvaptan (V2-receptor antagonist) for cirrhotic patients with hepatic edema in a real-world setting. Methods: In this retrospective, multicenter study, tolvaptan was orally administered at a dose of 7.5 mg once a day. Patients with a decrease in body weight of 1.5 kg or greater from baseline were characterized as responders at day 7. Results: Of 229 patients, 210 were subjected to this analysis. Patients consisted of 133 men and 77 women, with the median age of 67 years (range, 40-89 years). According to the Child-Pugh classification, five patients were classified as class A, 90 as class B, and 115 as class C. The frequencies of responders and nonresponders were 55.2% and 44.8%, respectively. Blood urea nitrogen (BUN) level was significantly lower in responders compared with nonresponders (P = 3.77 × 10-3). Using the receiver operating characteristic curve, the cutoff value of 28.2 mg/dL was the most useful in discriminating responders from nonresponders. Among 154 patients with BUN level of less than 28.2 mg/dL, 95 (61.7%) were responders. By contrast, among 56 patients with BUN level of 28.2 mg/dL or more, 21 (37.5%) were nonresponders (P = 2.70 × 10-3). On multivariate analysis, BUN level of <28.2 mg/dL and urine sodium >51 mEq/day were found to be independent factors associated with the response to tolvaptan. Conclusions: This study suggests that BUN level and urinary sodium excretion are closely associated with the response to tolvaptan in cirrhotic patients with hepatic edema.
- Subjects
CIRRHOSIS of the liver; LIVER diseases; BLOOD urea nitrogen; KIDNEY function tests; KIDNEY diseases
- Publication
Journal of Gastroenterology & Hepatology, 2018, Vol 33, Issue 6, p1256
- ISSN
0815-9319
- Publication type
Article
- DOI
10.1111/jgh.14047