Impact of acute kidney injury on prognosis and the effect of tolvaptan in patients with hepatic ascites

Background In hepatic cirrhosis, ascites and acute kidney injury (AKI) portend poor prognosis. We examined the incidence and characteristics of AKI in patients with hepatic ascites and the impact of diuretics on AKI onset. Methods This study included 337 patients with hepatic ascites treated with oral diuretics during September 2013–June 2019. Incidence of AKI, cumulative survival by AKI status, and prognostic factors were investigated. Patients were divided into those treated with tolvaptan (TLV) [TLV group ( n = 244)] and those not treated with TLV [control group ( n = 93)]. After propensity score matching, the incidence of AKI and changes in renal function and doses of diuretics were compared. Results The incidence of AKI overall was 35% ( n = 118). Patients with AKI had a significantly worse survival than those without AKI ( P = 0.001), indicating that AKI is an independent prognostic factor for hepatic ascites ( P = 0.025). After adjustment for background factors in the two groups ( n = 77 each), the TLV group had a significantly lower incidence of AKI (27.6% vs. 44.7%, P = 0.028). While renal function worsened with higher natriuretic agent doses in the control group, no significant change was observed in the TLV group, suggesting that TLV is an independent prognostic factor for AKI onset. Conclusions Our study suggests that concomitant AKI significantly worsens survival in Japanese patients with hepatic ascites, and TLV and natriuretic agent combination therapy might lead to an excellent synergistic therapeutic effect of hepatic ascites and inhibition of AKI onset.