Yasunari Hiramine1, Hirofumi Uto2,3, Seiichi Mawatari3, Shuji Kanmura3, Yasushi Imamura4, Takuya Hiwaki4, Akiko Saishoji4,3, Manei Oku3,5, Koichi Tokushige4, Shigeho Maenohara6, Akio Ido3. 1. Department of Internal Medicine, Kagoshima Kouseiren Hospital, 1-13-1 Yojiro, Kagoshima, 890-0062, Japan. hiramine0630@yahoo.co.jp. 2. Center for Digestive and Liver Diseases, Miyazaki Medical Center Hospital, 2-16 Takamatsu-cho, Miyazaki, 880-0003, Japan. 3. Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan. 4. Department of Internal Medicine, Kagoshima Kouseiren Hospital, 1-13-1 Yojiro, Kagoshima, 890-0062, Japan. 5. Department of Nephrology, Kagoshima Kouseiren Hospital, 1-13-1 Yojiro, Kagoshima, 890-0062, Japan. 6. Department of Surgery, Kagoshima Kouseiren Hospital, 1-13-1 Yojiro, Kagoshima, 890-0062, Japan.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Paolo Angeli; Pere Gines; Florence Wong; Mauro Bernardi; Thomas D Boyer; Alexander Gerbes; Richard Moreau; Rajiv Jalan; Shiv K Sarin; Salvatore Piano; Kevin Moore; Samuel S Lee; Francois Durand; Francesco Salerno; Paolo Caraceni; W Ray Kim; Vicente Arroyo; Guadalupe Garcia-Tsao Journal: Gut Date: 2015-01-28 Impact factor: 23.059
Authors: P Ginés; E Quintero; V Arroyo; J Terés; M Bruguera; A Rimola; J Caballería; J Rodés; C Rozman Journal: Hepatology Date: 1987 Jan-Feb Impact factor: 17.425
Authors: Justin M Belcher; Arun J Sanyal; Aldo J Peixoto; Mark A Perazella; Joseph Lim; Heather Thiessen-Philbrook; Naheed Ansari; Steven G Coca; Guadalupe Garcia-Tsao; Chirag R Parikh Journal: Hepatology Date: 2014-06-26 Impact factor: 17.425