Abstract
We investigated clinical features and therapeutic effect of tolvaptan in diuretic-resistant patients with refractory hydrothorax and/or ascites. Data were collected from 22 hospitalized patients with cirrhosis (HBV-positive 1; HCV-positive 8; alcoholic 2; others 11) after adding tolvaptan (3.75-7.5 mg/day) to conventional diuretics. A follow up assessment was conducted 1 week post-tolvaptan treatment for all the patients. Fifity-five percent of the patients decreased their body weight after the administration of tolvaptan. Tolvaptan was also effective against patients with liver failure and portal vein thrombosis. Serum BUN levels of no clinical improvement group were significantly higher than those of improvement group, which is reflecting the state of the underfilling. Furthermore, urine Na concentrations of no clinical improvement group were significantly lower. In addition, we experienced a case where the drinking water restriction exhibited a remarkable effect under tolvaptan treatment. Taking these findings together, it can be speculated that tolvaptan might not be effective on the pathogenesis of underfilling, and serum BUN and urine Na concentration could predict the therapeutic effect of tolvaptan.
