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Tolvaptan reduces the required amount of albumin infusion in patients with decompensated cirrhosis with uncontrolled ascites : a multicenter retrospective propensity score-matched cohort study

Journal Volume 84 - 2021
Issue Fasc.1 - Original articles
Author(s) Y. Suzuki 1 2 #, A. Naganuma 1 #, T. Hoshino 1, T. Hatanaka 1, T. Ueno 3, M. Namikawa 4, D. Takizawa 2, H. Arai 2, H. Suzuki 5, H. Takagi 6, H. Tojima 7, Y. Yamazaki 7, K. Sato 7, S. Kakizaki 7, T. Uraoka 7
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Affiliations:
(1) Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma 370-0829, Japan
(2) Department of Gastroenterology, Maebashi Red Cross Hospital, Maebashi, Gunma 371-0014, Japan
(3) Department of Internal Medicine, Isesaki Municipal Hospital, Isesaki, Gunma 372-0817, Japan
(4) Department of Internal Medicine, Kiryu Kosei General Hospital, Kiryu, Gunma 376-0024, Japan
(5) Department of Internal Medicine, Haramachi Red Cross Hospital, Higashiagatsuma, Gunma 377-0882, Japan
(6) Department of Gastroenterology, Kusunoki Hospital, Fujioka, Gunma 375-0024, Japan
(7) Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
(#) Contributed equally

Background: The aim of this retrospective study was to determine whether tolvaptan treatment reduces the amount of albumin administered, volume of ascites removed, and frequency of paracentesis procedures in patients with decompensated cirrhosis with uncontrolled ascites with conventional diuretics.

Patients and methods: The control (C) group included patients treated with conventional diuretics. The tolvaptan (T) group included patients treated with both tolvaptan and conventional diuretics. Both groups were matched according to baseline parameters. The amount of albumin administered, volume of ascites removed, and frequency of paracentesis within 30 days of onset of uncontrolled ascites were compared between the two groups.

Results: After matching, 74 patients (C=37, T=37) were included. Baseline parameters (C vs. T group) were as follows: age, 69.5 ± 9.3 vs. 70.4 ± 11.0 years (p = 0.702) ; males, 24 (64.9%) vs. 25 (67.6%) (p = 0.999) ; patients with hepatocellular carcinoma, 17 (45.9%) vs. 18 (48.6%) (p = 0.999) ; serum albumin levels at treatment initiation, 2.76 ± 0.48 vs. 2.73 ± 0.49 g/dL (p = 0.773), and serum creatinine levels at treatment initiation, 1.18 ± 1.23 vs. 1.09 ± 0.48 g/dL (p = 0.679). In the C vs. T groups, respectively, mean amount of albumin administered was 51.0 ± 31.4 vs. 33.4 ± 29.8 g/month (p = 0.016) ; mean volume of ascites removed was 2,905 ± 4,921 vs. 1,824 ± 3,185 mL/month (p = 0.266) ; and mean frequency of paracentesis was 0.92 ± 1.46 vs. 0.89 ± 1.45 procedures (p = 0.937).

Conclusions: Tolvaptan reduced the use of albumin infusion in patients with decompensated cirrhosis and was effective and acceptable for uncontrolled ascites.

Keywords: albumin infusion, cirrhosis, paracentesis, tolvaptan, uncontrolled ascites.

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PMID 33639694