Effects of low-dose tolvaptan on electrolyte abnormality and hemodynamic parameters in a liver cirrhosis-associated portopulmonary hypertension patient: A case report

Ogihara,Yoshito; Yamada,Norikazu; Dohi,Kaoru; Matsuda,Akimasa; Ota,Satoshi; Ishikura,Ken; Nakamura,Mashio; Ito,Masaaki

doi:10.3892/etm.2016.3945

January-2017 Volume 13 Issue 1

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January-2017 Volume 13 Issue 1

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Case Report

Effects of low-dose tolvaptan on electrolyte abnormality and hemodynamic parameters in a liver cirrhosis-associated portopulmonary hypertension patient: A case report

Authors:
- Yoshito Ogihara
- Norikazu Yamada
- Kaoru Dohi
- Akimasa Matsuda
- Satoshi Ota
- Ken Ishikura
- Mashio Nakamura
- Masaaki Ito
View Affiliations / Copyright

Affiliations: Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie 514‑8507, Japan
Pages: 269-272
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Published online on: December 1, 2016

https://doi.org/10.3892/etm.2016.3945
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Abstract

The present study reported a case of portopulmonary hypertension (POPH) that was secondary to underlying liver cirrhosis in a 58-year-old woman, who was successfully treated with low-dose tolvaptan. The patient had suffered from refractory peripheral edema and electrolyte abnormalities, including severe hypokalemia, under the combination therapy of sildenafil, ambrisentan, furosemide and spironolactone. Subsequent to the initiation of low‑dose tolvaptan at 3.75 mg/day with concurrent de‑escalation of the dose of furosemide, the daily urine volume increased, peripheral edema improved and the serum potassium level increased immediately. In addition, plasma renin activity, plasma aldosterone concentration and plasma brain natriuretic peptide level decreased within 1 week after the initiation of tolvaptan therapy. Hemodynamic assessments using a right heart catheter revealed that the pulmonary vascular resistance decreased by ~20%. Finally, chronic combination therapy with spironolactone and low‑dose tolvaptan without loop diuretics achieved adequate fluid management. In conclusion, the findings of the present study suggest that low‑dose tolvaptan may be a promising therapeutic option for liver cirrhosis‑associated POPH in patients with an electrolyte abnormality due to liver cirrhosis and conventional diuretics.

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1	Hoeper MM, Krowka MJ and Strassburg CP: Portopulmonary hypertension and hepatopulmonary syndrome. Lancet. 363:1461–1468. 2004. View Article : Google Scholar : PubMed/NCBI
2	Schrier RW: Use of diuretics in heart failure and cirrhosis. Semin Nephrol. 31:503–512. 2011. View Article : Google Scholar : PubMed/NCBI
3	Golbin JM and Krowka MJ: Portopulmonary hypertension. Clin Chest Med. 28:203–218. 2007. View Article : Google Scholar : PubMed/NCBI
4	Sakaida I, Yanase M, Kobayashi Y, Yasutake T, Okada M and Okita K: ASCITES Clinical Pharmacology Group: The pharmacokinetics and pharmacodynamics of tolvaptan in patients with liver cirrhosis with insufficient response to conventional diuretics: A multicentre, double-blind, parallel-group, phase III study. J Int Med Res. 40:2381–2393. 2012. View Article : Google Scholar : PubMed/NCBI
5	Sakaida I, Kawazoe S, Kajimura K, Saito T, Okuse C, Takaguchi K, Okada M and Okita K: Ascites-Doubleblind Study Group: Tolvaptan for improvement of hepatic edema: A phase 3, multicenter, randomized, double-blind, placebo-controlled trial. Hepatol Res. 44:73–82. 2014. View Article : Google Scholar : PubMed/NCBI
6	Okita K, Kawazoe S, Hasebe C, Kajimura K, Kaneko A, Okada M and Sakaida I: ASCITES Dose-Finding Trial Group: Dose-finding trial of tolvaptan in liver cirrhosis patients with hepatic edema: A randomized, double-blind, placebo-controlled trial. Hepatol Res. 44:83–91. 2014. View Article : Google Scholar : PubMed/NCBI
7	Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, Beghetti M, Corris P, Gaine S, Gibbs JS, et al: ESC Committee for Practice Guidelines (CPG): Guidelines for the diagnosis and treatment of pulmonary hypertension: The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J. 30:2493–2537. 2009. View Article : Google Scholar : PubMed/NCBI
8	Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC and Williams R: Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 60:646–649. 1973. View Article : Google Scholar : PubMed/NCBI
9	Ginés P, Berl T, Bernardi M, Bichet DG, Hamon G, Jiménez W, Liard JF, Martin PY and Schrier RW: Hyponatremia in cirrhosis: From pathogenesis to treatment. Hepatology. 28:851–864. 1998. View Article : Google Scholar : PubMed/NCBI
10	Pérez-Ayuso RM, Arroyo V, Planas R, et al: Randomized comparative study of efficacy of furosemide versus spironolactone in nonazotemic cirrhosis with ascites. Relationship between the diuretic response and the activity of the renin-aldosterone system. Gastroenterology. 84:961–968. 1983.PubMed/NCBI
11	Maron BA, Opotowsky AR, Landzberg MJ, Loscalzo J, Waxman AB and Leopold JA: Plasma aldosterone levels are elevated in patients with pulmonary arterial hypertension in the absence of left ventricular heart failure: A pilot study. Eur J Heart Fail. 15:277–283. 2013. View Article : Google Scholar : PubMed/NCBI
12	Preston IR, Sagliani KD, Warburton RR, Hill NS, Fanburg BL and Jaffe IZ: Mineralocorticoid receptor antagonism attenuates experimental pulmonary hypertension. Am J Physiol Lung Cell Mol Physiol. 304:L678–L688. 2013. View Article : Google Scholar : PubMed/NCBI

Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Effects of low-dose tolvaptan on electrolyte abnormality and hemodynamic parameters in a liver cirrhosis-associated portopulmonary hypertension patient: A case report

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