Diagnosis of refractory ascites

Abstract

Refractory ascites is a complication of decompensated liver cirrhosis and is an indicator of poor prognosis. Portal hypertension and renal sodium retention are involved in the occurrence of refractory ascites. The diagnosis of refractory ascites is based on the criteria advocated by the International Ascites Club (IAC). Exclusion of the conditions that induce transient refractoriness to diuretics is important in the differential diagnosis. In Japan, tolvaptan, an oral arginine vasopressin V2 receptor antagonist, has been used as a new diuretic for ascites in combination with conventional diuretics since the drug was approved in 2013. As the relation between renal dysfunction and poor prognosis has become evident, preservation of renal function should be considered while selecting therapeutic options. An appropriate combination of diuretic therapy using tolvaptan and conventional diuretics may offer the possibility to control ascites without deterioration of renal function. Further investigation to clarify the role of the novel diuretic drug, tolvaptan, in the treatment of cirrhotic refractory ascites is necessary.