Management of Cirrhotic Ascites under the Add-on Administration of Tolvaptan

Efficacy and Safety of Low-Dose Tolvaptan (7.5 mg) in the Treatment of Inpatient Hyponatremia: A Retrospective Study

OBJECTIVES

The recommended dose of tolvaptan for hyponatremia secondary to the syndrome of inappropriate antidiuretic hormone is 15 mg. We evaluated the efficacy of an initial 7.5 mg dose and determined the frequency where sodium (Na+) correction exceeded safe limits, defined as an increment of ≥10 mmol/L, within the initial 8 or 24 hours of administration.

METHODS

A retrospective review of patients with syndrome of inappropriate antidiuretic hormone treated in a single academic hospital in London. The initial dose was 7.5 mg and the second dose was 7.5 or 15 mg.

RESULTS

One hundred eighty-one patients were included. With the initial dose, the mean Na + increase was 4.54 ± 3.70 mmol/L (P < .0001) after 4-12 hours, with 8.7% demonstrating an increase exceeding 10 mmol/L. Between 18-30 hours, the mean Na + increase was 6.15 ± 3.51 mmol/L (P < .0001), with 19.4% over-correcting. Over-correction was more likely in patients with a pre-dose Na + concentration of ≤127 mmol/L (OR 13.64, 95% CI 1.80-102.95). No cases of osmotic demyelination syndrome were observed. For patients needing a second dose, the increment in Na + concentration showed no significant difference between 7.5 and 15 mg (P = .532).

CONCLUSION

In our view, tolvaptan can be initiated with a 7.5 mg dose, accompanied by Na + monitoring at 12 and 24 hours. If a second dose is necessary, 7.5 mg is comparably effective to a 15 mg dose, depending on the initial response. Further monitoring should include Na + concentration at around 24 hours after the second dose.

Clinical study on the relationship between liver cirrhosis, ascites, and hyponatremia

BACKGROUND

Cirrhosis is a common liver disease, and ascites is one of the common clinical conditions. However, the clinical manifestations of ascites combined with hyponatremia as a high-risk condition and its relationship to patient prognosis have not been fully studied.

AIM

To explore the clinical manifestations, prognostic factors, and relationships of ascites with hyponatremia in patients with cirrhosis to provide better diagnostic and treatment strategies.

METHODS

In this study, we retrospectively analyzed the clinical data of 150 patients diagnosed with cirrhosis and ascites between 2017 and 2022. Patients were divided into two groups: ascites combined with hyponatremia group and ascites group. We compared the general characteristics, degree of hyponatremia, complications, treatment, and prognosis between the two groups.

RESULTS

In the study results, patients in the ascites combined with hyponatremia group showed an older average age (58.2 ± 8.9 years), 64.4% were male, and had a significantly longer hospitalization time (12.7 ± 5.3 d). Hyponatremia was more severe in this group, with a mean serum sodium concentration of 128.5 ± 4.3 mmol/L, which was significantly different from the ascites group of 137.6 ± 2.1 mmol/L. Patients with ascites and hyponatremia were more likely to develop hepatic encephalopathy (56.2% vs 39.0%), renal impairment (45.2% vs 28.6%) and infection (37.0% vs 23.4%). Regarding treatment, this group more frequently used diuretics (80.8% vs 62.3%) and salt supplements (60.3% vs 38.9%). Multiple logistic regression analysis identified older age [Odds ratio (OR) = 1.06, P = 0.025] and male gender (OR = 1.72, P = 0.020) as risk factors for hyponatremia combined with ascites. Overall, patients with ascites and hyponatremia present a clear high-risk status, accompanied by severe complications and poor prognosis.

CONCLUSION

In patients with cirrhosis, ascites with hyponatremia is a high-risk condition that is often associated with severe complications.

Discovery and Characterization of RGH-122, a Potent, Selective, and Orally Bioavailable V1a Receptor Antagonist

The V1a receptor is a major contributor in mediating the social and emotional effects of arginine-vasopressin (AVP); therefore it represents a promising target in the treatment of several neuropsychiatric conditions. The aim of this research was to design and synthesize novel and selective V1a antagonists with improved in vitro and in vivo profiles. Through optimization and detailed SAR studies, we developed low nanomolar antagonists, and further characterizations led to the discovery of the clinical candidate compound 43 (RGH-122). The CNS activity of the compound was determined in a 3-chamber social preference test of autism in which RGH-122 successfully enhanced social preference with the lowest effective dose of 1.5 mg/kg.