The effects of diuretic use and the presence of ascites on muscle cramps in patients with cirrhosis: a nationwide study
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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 Yasuhiko Sawada1 • Makoto Shiraki2 • Motoh Iwasa3 • Atsushi Hiraoka4 • Hiroyuki Nakanishi5 • Yoshiyasu Karino6 • Tomoaki Nakajima6 • Hisamitsu Miyaaki7 Takumi Kawaguchi8 • Hitoshi Yoshiji1 • Kiwamu Okita9 • Kazuhiko Koike10
•
Received: 14 November 2019 / Accepted: 27 May 2020 Ó Japanese Society of Gastroenterology 2020
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 Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00535-020-01694-8) contains supplementary material, which is available to authorized users.
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 10
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
& Yasuhiko Sawada [email protected] 1
Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
2
Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
3
Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu, Japan
4
Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
5
Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
6
Department of Hepatology, Sapporo Kosei General Hospital, Sapporo, Japan
7
Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
8
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
9
Shunan Memorial Hospital, Yamaguchi, Japan
123
J Gastroenterol
analysis, diuretic administration and the ECW ratio values C 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
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