Research ArticleOpen AccessGoogle Scholar indexed
The Effect of Loop Diuretics on Sarcopenia and Long-Term Prognosis in Patients with Refractory Hepatic Ascites Treated with Tolvaptan
Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
- 1 Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
- 2 Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
- 3 Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
- 4 Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
- 5 Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
- 6 Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
- 7 Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
- 8 Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
- 9 Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
- 10 Department of Gastroenterology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
Open Journal of Gastroenterology·Volume 08 (2018)·Pages 201–208·Published 15 June 2018·DOI10.4236/ojgas.2018.86022
Copy link · social · email
Abstract
We investigated sarcopenia, focusing on the dose of loop diuretics used in 70 patients with refractory hepatic ascites treated with tolvaptan. Bloating improved in 68.5% of patients, as determined using the Japanese version of the Support Team Assessment Schedule. The psoas muscle index (PMI) was used to define sarcopenia. A statistically significant difference was observed in the PMI between patients receiving low-dose (3.6 ± 1.2 cm 2 /m 2 ) and high-dose furosemide (3.1 ± 1.2 cm 2 /m 2 ) before tolvaptan treatment (P = 0.048). The PMI increased from 3.2 ± 1.1 cm 2 /m 2 to 3.5 ± 1.3 cm 2 /m 2 (P = 0.002) in responders, but decreased from 3.4 ± 1.2 cm 2 /m 2 to 3.0 ± 1.0 cm 2 /m 2 (P = 0.106) in non-responders before and after tolvaptan treatment, respectively. The long-term prognosis improved in responders compared with non-responders (mean survival time: 646 days vs. 228 days, P < 0.001). Early introduction of tolvaptan treatment is necessary to prevent the progression of sarcopenia.
KeywordsTolvaptanHepatic AscitesSarcopeniaLoop DiureticsLong-Term Prognosis
- Llach, J., Gines, P., Arroyo, V., et al. (1988) Prognostic Value of Arterial Pressure, Endogenous Vasoactive Systems, and Renal Function in Cirrhotic Patients Admitted to the Hospital for the Treatment of Ascites. Gastroenterology, 94, 482-487. https://doi.org/10.1016/0016-5085(88)90441-6
- Sakaida, I., Kawazoe, S., Kajimura, K., et al. (2014) Tolvaptan for Improvement of Hepatic Edema: A Phase 3, Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial. Hepatology Research, 44, 73-82. https://doi.org/10.1111/hepr.12098
- Zmily, H.D., Daifallah, S. and Ghali, J.K. (2011) Tolvaptan, Hyponatremia, and Heart Failure. International Journal of Nephrology and Renovascular Disease, 4, 57-71.
- Larramona, G.L., Lucendo, A.J. and Tenias, J.M. (2015) Association between Nutritional Screening via the Controlling Nutritional Status Index and Bone Mineral Density in Chronic Liver Disease of Various Etiologies. Hepatology Research, 45, 618-628. https://doi.org/10.1111/hepr.12395
- Nishikawa, H., Shiraki, M., Hiramatsu, A., et al. (2016) Japan Society of Hepatology Guidelines for Sarcopenia in Liver Disease (1st Edition): Recommendation from the Working Group for Creation of Sarcopenia Assessment Criteria. Hepatology Research, 46, 951-963. https://doi.org/10.1111/hepr.12774
- Mandai, S., Furukawa, S., Kodaka, M., et al. (2017) Loop Diuretics Affect Skeletal Myoblast Differentiation and Exercise-Induced Muscle Hypertrophy. Scientific Reports, 7, Article Number: 46369. https://doi.org/10.1038/srep46369
- STAS Working Group. (2007) STAS-J (The Japanese Version Support Team Assessment Schedule) Scoring Manual. For Clinical Audit in the Palliative Care. Japan Hospice/Palliative Care Foundation, 3rd Edition, Koubunsya, Chiba, 1-93.
- Pugh, R.N.H., Murray-Lyon, I.M., Dawson, J.L., et al. (1973) Transection of the Oesophagus for Bleeding Oesophageal Varices. The British Journal of Surgery, 60, 646-649. https://doi.org/10.1002/bjs.1800600817
- Cruz-Jentoft, A.J., Baeyens, J.P., Bauer, J.M., et al. (2010) Sarcopenia: European Consensus on Definition and Diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age and Ageing, 39, 412-423. https://doi.org/10.1093/ageing/afq034
- Wilson, J.R., Mancini, D.M. and Dunkman, W.B. (1993) Exertional Fatigue Due to Skeletal Muscle Dysfunction in Patients with Heart Failure. Circulation, 87, 470-475. https://doi.org/10.1161/01.CIR.87.2.470
- Sharma, D., Hawkins, M. and Abramowitz, M.K. (2014) Association of Sarcopenia with eGFR and Misclassification of Obesity in Adults with CKD in the United States. Clinical Journal of the American Society of Nephrology, 9, 2079-2088. https://doi.org/10.2215/CJN.02140214