Impact of acute kidney injury on prognosis and the effect of tolvaptan in patients with hepatic ascites
| Autor: | Shuji Kanmura, Seiichi Mawatari, Hirofumi Uto, Akiko Saishoji, Takuya Hiwaki, Akio Ido, Shigeho Maenohara, Yasunari Hiramine, Koichi Tokushige, Manei Oku, Yasushi Imamura |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Liver Cirrhosis Male medicine.medical_specialty Cirrhosis Tolvaptan Renal function Administration Oral urologic and male genital diseases Gastroenterology 03 medical and health sciences 0302 clinical medicine Internal medicine Ascites Medicine Humans Diuretics Propensity Score Aged Retrospective Studies Aged 80 and over urogenital system business.industry Incidence Therapeutic effect Acute kidney injury Hepatology Acute Kidney Injury Middle Aged medicine.disease Prognosis Survival Analysis female genital diseases and pregnancy complications Treatment Outcome 030220 oncology & carcinogenesis Concomitant 030211 gastroenterology & hepatology Drug Therapy Combination Female medicine.symptom business Antidiuretic Hormone Receptor Antagonists medicine.drug |
| Zdroj: | Journal of gastroenterology. 56(1) |
| ISSN: | 1435-5922 |
| Popis: | In hepatic cirrhosis, ascites and acute kidney injury (AKI) portend poor prognosis. We examined the incidence and characteristics of AKI in patients with hepatic ascites and the impact of diuretics on AKI onset. This study included 337 patients with hepatic ascites treated with oral diuretics during September 2013–June 2019. Incidence of AKI, cumulative survival by AKI status, and prognostic factors were investigated. Patients were divided into those treated with tolvaptan (TLV) [TLV group (n = 244)] and those not treated with TLV [control group (n = 93)]. After propensity score matching, the incidence of AKI and changes in renal function and doses of diuretics were compared. The incidence of AKI overall was 35% (n = 118). Patients with AKI had a significantly worse survival than those without AKI (P = 0.001), indicating that AKI is an independent prognostic factor for hepatic ascites (P = 0.025). After adjustment for background factors in the two groups (n = 77 each), the TLV group had a significantly lower incidence of AKI (27.6% vs. 44.7%, P = 0.028). While renal function worsened with higher natriuretic agent doses in the control group, no significant change was observed in the TLV group, suggesting that TLV is an independent prognostic factor for AKI onset. Our study suggests that concomitant AKI significantly worsens survival in Japanese patients with hepatic ascites, and TLV and natriuretic agent combination therapy might lead to an excellent synergistic therapeutic effect of hepatic ascites and inhibition of AKI onset. |
| Databáze: | OpenAIRE |
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