Impact of acute kidney injury on prognosis and the effect of tolvaptan in patients with hepatic ascites.
Acute Kidney Injury
/ diagnosis
Administration, Oral
Adult
Aged
Aged, 80 and over
Antidiuretic Hormone Receptor Antagonists
/ therapeutic use
Ascites
/ complications
Diuretics
/ therapeutic use
Drug Therapy, Combination
Female
Humans
Incidence
Liver Cirrhosis
/ complications
Male
Middle Aged
Prognosis
Propensity Score
Retrospective Studies
Survival Analysis
Tolvaptan
/ therapeutic use
Treatment Outcome
Acute kidney injury
Cirrhosis
Hepatic ascites
Prognosis
Tolvaptan
Journal
Journal of gastroenterology
ISSN: 1435-5922
Titre abrégé: J Gastroenterol
Pays: Japan
ID NLM: 9430794
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
19
04
2020
accepted:
07
09
2020
pubmed:
23
9
2020
medline:
30
11
2021
entrez:
22
9
2020
Statut:
ppublish
Résumé
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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 32959093
doi: 10.1007/s00535-020-01727-2
pii: 10.1007/s00535-020-01727-2
doi:
Substances chimiques
Antidiuretic Hormone Receptor Antagonists
0
Diuretics
0
Tolvaptan
21G72T1950
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
54-66Références
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