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Erschienen in: Journal of Gastroenterology 9/2020

12.06.2020 | Original Article—Liver, Pancreas, and Biliary Tract

The effects of diuretic use and the presence of ascites on muscle cramps in patients with cirrhosis: a nationwide study

verfasst von: Yasuhiko Sawada, Makoto Shiraki, Motoh Iwasa, Atsushi Hiraoka, Hiroyuki Nakanishi, Yoshiyasu Karino, Tomoaki Nakajima, Hisamitsu Miyaaki, Takumi Kawaguchi, Hitoshi Yoshiji, Kiwamu Okita, Kazuhiko Koike

Erschienen in: Journal of Gastroenterology | Ausgabe 9/2020

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Abstract

Background

Administration of diuretics and the presence of ascites in patients with cirrhosis were reported to be associated with muscle cramps; however, the clinical evidence is limited. This study aimed to determine whether muscle cramps are a diuretic-induced complication and whether ascites was a factor related to muscle cramp.

Methods

A total of 1064 adult patients with cirrhosis were enrolled from 10 hospitals in Japan between June 2017 and December 2018. A questionnaire regarding cramps was completed by all patients. The ratio of extracellular water (ECW) was analyzed using the bioelectrical impedance analysis. Logistic regression analysis was performed to analyze the effects of diuretic administration and the ECW ratio on cramps.

Results

Patients using diuretics had a higher incidence rate, higher frequency, stronger pain, and longer duration of cramps than those who did not. In the multivariate analysis, diuretic administration and the ECW ratio values ≥ 0.4 were not significantly associated with the presence, frequency, intensity, or duration of cramps. However, in the case of patients limited to Child–Pugh B or C, diuretic use was significantly correlated with the cramp frequency.

Conclusions

These results demonstrated that muscle cramps were not a complication of diuretic use in patients with cirrhosis; however, in those limited to Child–Pugh B or C, diuretic use was a factor that affected the frequency of cramps. Moreover, no association was found between the presence of ascites and cramps.
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Literatur
1.
Zurück zum Zitat Fukui H, Saito H, Ueno Y, et al. Evidence-based clinical practice guidelines for liver cirrhosis 2015. J Gastroenterol. 2016;51:629–50.CrossRef Fukui H, Saito H, Ueno Y, et al. Evidence-based clinical practice guidelines for liver cirrhosis 2015. J Gastroenterol. 2016;51:629–50.CrossRef
2.
Zurück zum Zitat Namba M, Hiramatsu A, Aikata H, et al. Management of refractory ascites attenuates muscle mass reduction and improves survival in patients with decompensated cirrhosis. J Gastroenterol. 2020;55:217–26.CrossRef Namba M, Hiramatsu A, Aikata H, et al. Management of refractory ascites attenuates muscle mass reduction and improves survival in patients with decompensated cirrhosis. J Gastroenterol. 2020;55:217–26.CrossRef
3.
Zurück zum Zitat Kitajima Y, Takahashi H, Akiyama T, et al. Supplementation with branched-chain amino acids ameliorates hypoalbuminemia, prevents sarcopenia, and reduces fat accumulation in the skeletal muscles of patients with liver cirrhosis. J Gastroenterol. 2018;53:427–37.CrossRef Kitajima Y, Takahashi H, Akiyama T, et al. Supplementation with branched-chain amino acids ameliorates hypoalbuminemia, prevents sarcopenia, and reduces fat accumulation in the skeletal muscles of patients with liver cirrhosis. J Gastroenterol. 2018;53:427–37.CrossRef
4.
Zurück zum Zitat Konikoff F, Theodor E. Painful muscle cramps. A symptom of liver cirrhosis? J Clin Gastroenterol. 1986;8:669-72. Konikoff F, Theodor E. Painful muscle cramps. A symptom of liver cirrhosis? J Clin Gastroenterol. 1986;8:669-72.
5.
Zurück zum Zitat Abrams GA, Concato J, Fallon MB. Muscle cramps in patients with cirrhosis. Am J Gastroenterol. 1996;91:1363–6.PubMed Abrams GA, Concato J, Fallon MB. Muscle cramps in patients with cirrhosis. Am J Gastroenterol. 1996;91:1363–6.PubMed
6.
Zurück zum Zitat Angeli P, Albino G, Carraro P, et al. Cirrhosis and muscle cramps: evidence of a causal relationship. Hepatology. 1996;23:264–73.CrossRef Angeli P, Albino G, Carraro P, et al. Cirrhosis and muscle cramps: evidence of a causal relationship. Hepatology. 1996;23:264–73.CrossRef
7.
Zurück zum Zitat Marotta PJ, Graziadei IW, Ghent CN. Muscle cramps: a ‘complication’ of cirrhosis. Can J Gastroenterol. 2000;14 Suppl D:21D–5D. Marotta PJ, Graziadei IW, Ghent CN. Muscle cramps: a ‘complication’ of cirrhosis. Can J Gastroenterol. 2000;14 Suppl D:21D–5D.
8.
Zurück zum Zitat Ghabril M, Jackson M, Gotur R, et al. Most individuals with advanced cirrhosis have sleep disturbances, which are associated with poor quality of life. Clin Gastroenterol Hepatol. 2017;15(1271–8):e6. Ghabril M, Jackson M, Gotur R, et al. Most individuals with advanced cirrhosis have sleep disturbances, which are associated with poor quality of life. Clin Gastroenterol Hepatol. 2017;15(1271–8):e6.
9.
Zurück zum Zitat Kobayashi Y, Kawasaki T, Yoshimi T, et al. Muscle cramps in chronic liver diseases and treatment with antispastic agent (eperisone hydrochloride). Dig Dis Sci. 1992;37:1145–6.CrossRef Kobayashi Y, Kawasaki T, Yoshimi T, et al. Muscle cramps in chronic liver diseases and treatment with antispastic agent (eperisone hydrochloride). Dig Dis Sci. 1992;37:1145–6.CrossRef
10.
Zurück zum Zitat Konikoff F. The therapeutic benefit of vitamin E in patients with liver disease. J Hepatol. 1994;21:687–8.CrossRef Konikoff F. The therapeutic benefit of vitamin E in patients with liver disease. J Hepatol. 1994;21:687–8.CrossRef
11.
Zurück zum Zitat Baskol M, Ozbakir O, Coskun R, et al. The role of serum zinc and other factors on the prevalence of muscle cramps in non-alcoholic cirrhotic patients. J Clin Gastroenterol. 2004;38:524–9.CrossRef Baskol M, Ozbakir O, Coskun R, et al. The role of serum zinc and other factors on the prevalence of muscle cramps in non-alcoholic cirrhotic patients. J Clin Gastroenterol. 2004;38:524–9.CrossRef
12.
Zurück zum Zitat Jansen PH, Joosten EM, Vingerhoets HM. Muscle cramp: main theories as to aetiology. Eur Arch Psychiatry Neurol Sci. 1990;239:337–42.CrossRef Jansen PH, Joosten EM, Vingerhoets HM. Muscle cramp: main theories as to aetiology. Eur Arch Psychiatry Neurol Sci. 1990;239:337–42.CrossRef
13.
Zurück zum Zitat Kugelmas M. Preliminary observation: oral zinc sulfate replacement is effective in treating muscle cramps in cirrhotic patients. J Am Coll Nutr. 2000;19:13–5.CrossRef Kugelmas M. Preliminary observation: oral zinc sulfate replacement is effective in treating muscle cramps in cirrhotic patients. J Am Coll Nutr. 2000;19:13–5.CrossRef
14.
Zurück zum Zitat European Association for the Study of the Liver. Electronic address eee, European Association for the Study of the L. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69:406–60. European Association for the Study of the Liver. Electronic address eee, European Association for the Study of the L. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69:406–60.
15.
Zurück zum Zitat Chatrath H, Liangpunsakul S, Ghabril M, et al. Prevalence and morbidity associated with muscle cramps in patients with cirrhosis. Am J Med. 2012;125:1019–25.CrossRef Chatrath H, Liangpunsakul S, Ghabril M, et al. Prevalence and morbidity associated with muscle cramps in patients with cirrhosis. Am J Med. 2012;125:1019–25.CrossRef
16.
Zurück zum Zitat Hara N, Iwasa M, Iwata K, et al. Value of the extracellular water ratio for assessment of cirrhotic patients with and without ascites. Hepatol Res. 2009;39:1072–9.CrossRef Hara N, Iwasa M, Iwata K, et al. Value of the extracellular water ratio for assessment of cirrhotic patients with and without ascites. Hepatol Res. 2009;39:1072–9.CrossRef
17.
Zurück zum Zitat Sakaida I, Kawazoe S, Kajimura K, et al. Tolvaptan for improvement of hepatic edema: a phase 3, multicenter, randomized, double-blind, placebo-controlled trial. Hepatol Res. 2014;44:73–82.CrossRef Sakaida I, Kawazoe S, Kajimura K, et al. Tolvaptan for improvement of hepatic edema: a phase 3, multicenter, randomized, double-blind, placebo-controlled trial. Hepatol Res. 2014;44:73–82.CrossRef
18.
Zurück zum Zitat Sakaida I, Yamashita S, Kobayashi T, et al. Efficacy and safety of a 14-day administration of tolvaptan in the treatment of patients with ascites in hepatic oedema. J Int Med Res. 2013;41:835–47.CrossRef Sakaida I, Yamashita S, Kobayashi T, et al. Efficacy and safety of a 14-day administration of tolvaptan in the treatment of patients with ascites in hepatic oedema. J Int Med Res. 2013;41:835–47.CrossRef
19.
Zurück zum Zitat Hiramine Y, Uojima H, Nakanishi H, Hiramatsu A, Iwamoto T, Kimura M, et al. Response criteria of tolvaptan for the treatment of hepatic edema. J Gastroenterol. 2018;53(2):258–68 Epub 2017/07/01.CrossRef Hiramine Y, Uojima H, Nakanishi H, Hiramatsu A, Iwamoto T, Kimura M, et al. Response criteria of tolvaptan for the treatment of hepatic edema. J Gastroenterol. 2018;53(2):258–68 Epub 2017/07/01.CrossRef
20.
Zurück zum Zitat Iwasa M, Karino Y, Kawaguchi T, et al. Relationship of muscle cramps to quality of life and sleep disturbance in patients with chronic liver diseases: a nationwide study. Liver Int. 2018;38:2309–16.CrossRef Iwasa M, Karino Y, Kawaguchi T, et al. Relationship of muscle cramps to quality of life and sleep disturbance in patients with chronic liver diseases: a nationwide study. Liver Int. 2018;38:2309–16.CrossRef
21.
Zurück zum Zitat Hiraoka A, Yoshiji H, Iwasa M, et al. Clinical features of liver cirrhosis patients with muscle cramping: a multicenter study. Eur J Gastroenterol Hepatol. 2019;31:1557–62.CrossRef Hiraoka A, Yoshiji H, Iwasa M, et al. Clinical features of liver cirrhosis patients with muscle cramping: a multicenter study. Eur J Gastroenterol Hepatol. 2019;31:1557–62.CrossRef
22.
Zurück zum Zitat Giuriato G, Pedrinolla A, Schena F, et al. Muscle cramps: a comparison of the two-leading hypothesis. J Electromyogr Kinesiol. 2018;41:89–95.CrossRef Giuriato G, Pedrinolla A, Schena F, et al. Muscle cramps: a comparison of the two-leading hypothesis. J Electromyogr Kinesiol. 2018;41:89–95.CrossRef
23.
Zurück zum Zitat Chari VR, Katiyar BC, Rastogi BL, et al. Neuropathy in hepatic disorders. A clinical, electrophysiological and histopathological appraisal. J Neurol Sci. 1977;31:93–111.CrossRef Chari VR, Katiyar BC, Rastogi BL, et al. Neuropathy in hepatic disorders. A clinical, electrophysiological and histopathological appraisal. J Neurol Sci. 1977;31:93–111.CrossRef
24.
25.
Zurück zum Zitat Kawaguchi T, Izumi N, Charlton MR, et al. Branched-chain amino acids as pharmacological nutrients in chronic liver disease. Hepatology. 2011;54:1063–70.CrossRef Kawaguchi T, Izumi N, Charlton MR, et al. Branched-chain amino acids as pharmacological nutrients in chronic liver disease. Hepatology. 2011;54:1063–70.CrossRef
26.
Zurück zum Zitat Matsuzaki Y, Tanaka N, Osuga T. Is taurine effective for treatment of painful muscle cramps in liver cirrhosis? Am J Gastroenterol. 1993;88:1466–7.PubMed Matsuzaki Y, Tanaka N, Osuga T. Is taurine effective for treatment of painful muscle cramps in liver cirrhosis? Am J Gastroenterol. 1993;88:1466–7.PubMed
27.
Zurück zum Zitat Simchak AC, Pascuzzi RM. Muscle cramps. Semin Neurol. 1991;11:281–7.CrossRef Simchak AC, Pascuzzi RM. Muscle cramps. Semin Neurol. 1991;11:281–7.CrossRef
28.
Zurück zum Zitat Garrison SR, Allan GM, Sekhon RK, et al. Magnesium for skeletal muscle cramps. Cochrane Database Syst Rev. 2012;9:CD009402. Garrison SR, Allan GM, Sekhon RK, et al. Magnesium for skeletal muscle cramps. Cochrane Database Syst Rev. 2012;9:CD009402.
29.
Zurück zum Zitat Lindsay RM, Shulman T, Prakash S, et al. Hemodynamic and volume changes during hemodialysis. Hemodial Int. 2003;7:204–8.CrossRef Lindsay RM, Shulman T, Prakash S, et al. Hemodynamic and volume changes during hemodialysis. Hemodial Int. 2003;7:204–8.CrossRef
30.
Zurück zum Zitat Sawada Y, Kawaratani H, Kubo T, et al. Effect of furosemide on muscle cramps in patients with liver cirrhosis. J Gastroenterol Hepatol. 2020;35:76–81.CrossRef Sawada Y, Kawaratani H, Kubo T, et al. Effect of furosemide on muscle cramps in patients with liver cirrhosis. J Gastroenterol Hepatol. 2020;35:76–81.CrossRef
31.
Zurück zum Zitat Mosenkis A, Townsend RR. Muscle cramps and diuretic therapy. J Clin Hypertens (Greenwich). 2005;7:134–5.CrossRef Mosenkis A, Townsend RR. Muscle cramps and diuretic therapy. J Clin Hypertens (Greenwich). 2005;7:134–5.CrossRef
32.
Zurück zum Zitat Leemhuis MP, Struyvenberg A. Significance of hypokalaemia due to diuretics. Neth J Med. 1973;16:18–28.PubMed Leemhuis MP, Struyvenberg A. Significance of hypokalaemia due to diuretics. Neth J Med. 1973;16:18–28.PubMed
33.
Zurück zum Zitat Hutcheon D, Vincent ME, Sandhu RS. Clinical use of diuretics in congestive heart failure. J Clin Pharmacol. 1981;21:668–72.CrossRef Hutcheon D, Vincent ME, Sandhu RS. Clinical use of diuretics in congestive heart failure. J Clin Pharmacol. 1981;21:668–72.CrossRef
34.
Zurück zum Zitat Fukui H. Do vasopressin V2 receptor antagonists benefit cirrhotics with refractory ascites? World J Gastroenterol. 2015;21:11584–96.CrossRef Fukui H. Do vasopressin V2 receptor antagonists benefit cirrhotics with refractory ascites? World J Gastroenterol. 2015;21:11584–96.CrossRef
35.
Zurück zum Zitat Gines P, Guevara M, Arroyo V, et al. Hepatorenal syndrome. Lancet. 2003;362:1819–27.CrossRef Gines P, Guevara M, Arroyo V, et al. Hepatorenal syndrome. Lancet. 2003;362:1819–27.CrossRef
Metadaten
Titel
The effects of diuretic use and the presence of ascites on muscle cramps in patients with cirrhosis: a nationwide study
verfasst von
Yasuhiko Sawada
Makoto Shiraki
Motoh Iwasa
Atsushi Hiraoka
Hiroyuki Nakanishi
Yoshiyasu Karino
Tomoaki Nakajima
Hisamitsu Miyaaki
Takumi Kawaguchi
Hitoshi Yoshiji
Kiwamu Okita
Kazuhiko Koike
Publikationsdatum
12.06.2020
Verlag
Springer Singapore
Erschienen in
Journal of Gastroenterology / Ausgabe 9/2020
Print ISSN: 0944-1174
Elektronische ISSN: 1435-5922
DOI
https://doi.org/10.1007/s00535-020-01694-8

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