The effect of 1 month of therapy with midodrine,octreotide‐LAR and albumin in refractory ascites: a pilot study |
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Authors: | Puneeta Tandon Ross T Tsuyuki Lesley Mitchell Michael Hoskinson Mang M Ma Winnie W Wong Andrew L Mason Klaus Gutfreund Vincent G Bain |
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Institution: | 1. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada;2. Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada;3. Department of Radiology, University of Alberta, Edmonton, Alberta, Canada |
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Abstract: | Background: The pathogenesis of refractory ascites (RA) is linked to splanchnic vasodilation. We hypothesized that a combination of midodrine, octreotide long‐acting release (LAR) and albumin would result in increased natriuresis, better control of ascites and an improvement in renal function in patients with RA±Type 2 hepatorenal syndrome. Methods: A prospective pilot study in patients with RA as defined by the International Ascites Club. Consecutive patients received an intramuscular injection of octreotide‐LAR, 50 g of albumin three times per week and midodrine titrated to increase the systolic blood pressure for 1 month. Results: Ten patients with RA were enrolled and eight with complete data to 1 month post‐treatment were included in the analysis. There was no change in renal function but there was a trend towards a reduction in the volume of ascites removed by paracentesis (P=0.08) and a significant reduction in the plasma renin (P=0.01) and aldosterone concentrations (P=0.01). Interestingly, there was a transient worsening in the model for end‐stage liver disease (MELD) score (P=0.01). The deterioration in MELD was completely reversible after discontinuation of therapy. Conclusions: To our knowledge, this is the first study of prolonged midodrine, octreotide and albumin therapy in RA. We observed a significant reduction in the plasma renin and aldosterone concentrations and a trend towards a reduction in the volume of ascites removed by paracentesis without an effect on renal function. The beneficial effects are at the expense of a reversible deterioration in the MELD score. Large controlled trials are needed before this therapy can be routinely recommended. |
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Keywords: | albumin ascites hepatorenal syndrome midodrine octreotide refractory ascites |
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