{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T09:11:18Z","timestamp":1754557878727,"version":"3.40.5"},"reference-count":38,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2020,12,9]],"date-time":"2020-12-09T00:00:00Z","timestamp":1607472000000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hepatology Research"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>Tolvaptan is a newly available diuretic that has a specific function in water reabsorption inhibition. Given that spironolactone or furosemide induces the aggravation of cirrhotic hyponatremia and dehydration, tolvaptan affects the management strategy of liver cirrhosis. Representative predictive markers of its response include renal function\u2010related markers such as urea nitrogen or creatinine. However, vascular function\u2010related markers have not been well investigated. We investigated the effect of the vascular function\u2010related marker asymmetric dimethylarginine (ADMA) and the effective arterial blood volume (EABV) marker, fractional excretion of sodium (FENa), on the early tolvaptan response and survival in liver cirrhosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prospectively recruited 49 patients who required add\u2010on tolvaptan for refractory ascites or edema. Laboratory data were obtained immediately before and 1\u00a0day after tolvaptan administration. Patients exhibiting &gt;1.5\u00a0kg weight loss after 1\u00a0week were categorized as early responders to tolvaptan. Patients were followed for a median of 200\u00a0days and were assessed for survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Early responders showed lower creatinine levels (&lt;1.0\u00a0mg\/dL), and higher ADMA levels (\u22650.61\u00a0nmol\/mL) than others in a multivariate analysis. Patients with a shorter survival were positive for hepatocellular carcinoma and had a low FENa (&lt;0.35%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Early responders showed higher ADMA levels reflecting vascular stricture, suggesting that higher vascular tonus is required for a tolvaptan early response. Patients with a shorter survival showed a lower FENa, reflecting a lower EABV and suggesting that adequate EABV is required for the prolonged survival after tolvaptan administration.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hepr.13573","type":"journal-article","created":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T07:07:11Z","timestamp":1600326431000},"page":"1347-1354","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["High expression of a vascular stricture\u2010related marker is predictive of an early response to tolvaptan, and a low fractional excretion of sodium is predictive of a poor long\u2010term survival after tolvaptan administration for liver cirrhosis"],"prefix":"10.1111","volume":"50","author":[{"given":"Takuya","family":"Adachi","sequence":"first","affiliation":[{"name":"Departments of Gastroenterology and Hepatology, and Medical Science Okayama University Graduate School of Medicine, Dentistry and 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