ObjectiveTo observe and evaluate the efficacy of tolvaptan for the hepatogenic refractory ascites, when treatment is ineffective with traditional diuretic drugs.
MethodsA series of 41 patients with liver cirrhosis refractory ascites were enrolled. Traditional diuretic drugs were invalid for them. All patients were treated with tolvaptan (7.5 or 15 mg/d) and diuretic drugs (spironolactone 40-120 mg/d and furosemide 20-60 mg/d) for at least one week. Then the biochemical indices and urine volume were compared between pre- and post-treatment with tolvaptan. The doses of tolvaptan were based on the urine volume of the first three days: for patients with no obvious increasing urine(urine volume increase less than 500 mL), the tolvaptan doses increased to 15 mg/d; for patients with increasing urine(urine volume increase between 500 mL to 1 500 mL), the tolvaptan doses were maintained; for patients with obvious increasing urine(urine volume increase more than 1 500 mL), the tolvaptan dose changed to 7.5 mg/d. During the seven days, the efficacy and the adverse events were observed.
ResultsThere were nine patients taking increasing dosage of tolvaptan instead of the invalid starting dose. Among them, two patients' urine increased obviously and their ascites subsided. However, there was no statistic significant improvement on the urine volume before and after increasing tolvaptan dosage (1 960.00±510.59)mL vs. (2 161.11±956.81)mL, P=0.452. Among the eight patients who had a good response to starting dose and subsequently decreased the dose, only one patient's urine decreased greatly. The urine volume decreased after changing the tolvaptan dose(4 281.25±445.37)mL vs. (3048.75±710.88)mL, P=0.001. After treating with tolvaptan for seven days, patients' urine increased (1 484.05±612.0)mL vs. (2 508.92±887.97)mL, P < 0.001. The percentage of patients showed improvement in their ascites was 63.41%, while the alleviate edema rate of legs was 68.29% and the hyponatremia improvement rate was 50%(131.88±4.59)mmol/L vs. (134.68±6.3)mmol/L, P=0.03. Tolvaptan contributed little to the dysfunction of liver. Liver cirrhosis degree Child-Pugh classification affected the efficacy of tolvaptan. The main adverse reaction was dry mouth.
ConclusionTolvaptan promotes urinary and water excretion and improve hyponatremia for patients having poor response to traditional diuretic, when the starting dosage is invalid and there is no curative effect increased even if the dose is increased. However, those patients with the starting dose significantly effective have their urine volume remarkably increased though the curative effect decreased as the dosage decreased.
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