**5. Conclusions**

This is the first report to reveal that tolvaptan can improve survival, especially when tolvaptan treatment is started before high-dose furosemide administration. Therapy for RA has drastically changed, and clinicians give tolvaptan early for RA rather than increasing the doses of conventional diuretics. The limitations of this study are the small number of patients and the retrospective nature of this study. Prospective and double-blind studies should be better, but tolvaptan has been reported to be quite effective in short-term and long-term administration. It might be difficult to prove it by prospective study.

**Supplementary Materials:** The following are available online at https://www.mdpi.com/2077-038 3/10/2/294/s1, Figure S1: Comparison of cumulative survival rates between the tolvaptan group with HCC and without HCC.

**Author Contributions:** A.H.: study concept and design, acquisition of data; T.T., T.O., M.A., K.O., Y.W., Y.K., T.Y. (Toshio Yamaguchi), Y.S., M.H., and T.Y. (Takuya Yamada), acquisition of data; N.H., analysis and interpretation of data, funding procurement. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Institutional Review Board Statement:** The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the ethics committee of Osaka-Rosai Hospital (protocol 20150024, the date of approval; 5 September 2015).

**Informed Consent Statement:** Informed consent was obtained from all subjects involved in the study.

**Data Availability Statement:** Data is contained within the article or Supplementary Materials.

**Acknowledgments:** We are grateful to Shokura H, Izutani Y and Kuyama Y (our medical assistants) for collecting the large amounts of data analyzed in this study. This study was supported by a Grant-in-Aid for Research on Hepatitis from the Ministry of Health, Labor, and Welfare of Japan and the Japan Agency for Medical Research and Development (17fk0210106h0901).

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**

