Bumetanide, Spironolactone and a Combination of the Two, in the Treatment of Ascites due to Liver Disease

Abstract

There are few studies available comparing the efficacy of loop and distal diuretics and a combination of the two groups, in the treatment of ascites due to liver disease. Thirty-seven nonazotemic cirrhotic patients with ascites were randomly allocated to receive for 2 weeks bumetanide (group A, n = 13), spironolactone (group B, n = 12) or a combination of the two drugs (group C, n = 12) after a 5-day stabilization period. The response to the treatment was 69, 42 and 83% in groups A, B and C, respectively; the difference was not significant. Hypokalemia was seen in 4 patients of group A and mild hyperkalemia in 2 patients of group B. Electrolyte disturbances were minimal in patients of group C. The response to diuretic treatment was prompt in groups A and C. It can be concluded that a combination of loop and distal diuretics is superior to a one-drug regimen in achieving a rapid and better diuretic response with fewer side effects.

Guidelines on the management of ascites in cirrhosis

“…However it is not as effective, an earlier RCT showing response rates of 35% vs 70% in those receiving amiloride versus potassium canrenoate, respectively. 92 Other diuretics which have been used in patients with cirrhosis and ascites include bumetanide 93 and torasemide. 94 95…”

Hyponatremia and other electrolyte/ion disorders

“…Hypokalemia is common in patients treated with diuretics. Up to 30% of patients with cirrhosis and ascites treated with loop diuretics develop hypokalemia [71]. There are two main reasons for the high prevalence of hypokalemia in patients treated by loop diuretics: (i) loop diuretics reduce the reabsorption of potassiun in the loop of Henle; and (ii) loop diuretics increase the sodium delivery into the distal tubule where secondary hyperaldosteronism leads to an increased reabsorption of sodium and secretion of potassium.…”