| [ Summary ] |
Ascites is a complication of decompensated cirrhosis that impairs quality of life (QOL) in patients. Portal hypertension, hypoalbuminemia, and arterial splanchnic vasodilatation result in abnormalities in body fluid distribution, and following a reduction in the effective circulating plasma volume, these changes cause sodium and water reabsorption in the kidney with consequent increase in ascites. Diuretic therapy suppresses reabsorption in the kidney. Tolvaptan, a novel diuretic agent that acts as an antagonist of vasopressin V2 receptor, has been added to the treatment options, which only included spironolactone and furosemide. Evidence‒based Clinical Practice Guidelines for Liver Cirrhosis 2015 have recommended that the combined administration of the 3 aforementioned agents is associated with low rates of adverse effects. It should be understood that diuretic treatment is not the radical treatment for ascites (which is primarily a disturbance/abnormality in the distribution of body fluids) and that diuretics are administered only as symptomatic treatment. It is important to improve the nutritional status and QOL in patients using salt restriction and albumin administration, among other such strategies. Additionally, it is important to focus on reducing the risk of complications such as hepatic encephalopathy, renal dysfunction, and electrolyte imbalance. |