Effects of a 7-day treatment with midodrine in non-azotemic cirrhotic patients with and without ascites

Kalambokis, Georgios; Fotopoulos, Andreas; Economou, Michael; Παππάς, Κωνσταντίνος; Tsianos, Epameinondas V.

doi:10.1016/j.jhep.2006.09.012

Cited by 68 publications

(88 citation statements)

References 39 publications

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“…However, these findings may have been blurred, as the urine production was not stimulated by oral water ingestion and a catheter did not collect the urine, and only 3 patients had In a recent study, 12 patients with ascites were treated with the alpha-1-adrenergic agonist midodrine for 7 days. 24 Following a delay of 3-5 days, a significant increase in GFR, U Na , V u , and creatinine clearance was seen. In another study on acute effects of midodrine, an improvement in GFR and U Na was observed in patients with ascites, and no effect was seen in patients with type 2 HRS.…”

Section: Discussionmentioning

confidence: 96%

Terlipressin improves renal function in patients with cirrhosis and ascites without hepatorenal syndrome

et al. 2007

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Patients with advanced cirrhosis and ascites are characterized by circulatory dysfunction with splanchnic vasodilatation and renal vasoconstriction, which often lead to ascites. The vasoconstrictor terlipressin improves renal function in hepatorenal syndrome (HRS). The aim of this study was to evaluate if terlipressin also improves renal function in patients with ascites without HRS. Twenty-three patients with cirrhosis participated; 15 with nonrefractory ascites were randomized to either terlipressin (N group, n ‫؍‬ 11) or a placebo (P group, n ‫؍‬ 4), and 8 had refractory ascites and received terlipressin (R group). The glomerular filtration rate (GFR), sodium clearance (C Na ), lithium clearance (C Li ), osmolal clearance (C Osm ), and urine sodium concentration (U Na ) were assessed before and after the injection of 2 mg of terlipressin or the placebo. GFR increased in the N group (69 ؎ 19 versus 92 ؎ 25 mL/min, P < 0.005) and in the R group (31 ؎ 19 versus 41 ؎ 31 mL/min, P < 0.05) after terlipressin. In the N group, terlipressin induced an increase in C Na (0.89 ؎ 0.21 versus 1.52 ؎ 1.45 mL/min, P < 0.05), C Li (17.3 ؎ 8.9 versus 21.5 ؎ 11.6 mL/min, P < 0.05), and C Osm (2.10 ؎ 0.81 versus 3.06 ؎ 2.0 mL/min, P < 0.05). In the R group, terlipressin induced an increase in C Na (0.11 ؎ 0.18 versus 0.35 ؎ 0.40 mL/min, P < 0.05) and C Li (5.5 ؎ 4.2 versus 9.5 ؎ 8.55 mL/min, P < 0.05). U Na increased in both groups after terlipressin (P < 0.005). Plasma norepinephrine (P < 0.05) and renin (P < 0.05) decreased after terlipressin. All parameters remained unchanged after the placebo. A scites is a serious complication of cirrhosis, occurring in about 50% of patients within 10 years after diagnosis, and it is associated with 50% mortality in 2 years. 1,2 Patients with ascites have hyperdynamic circulation, which is characterized by peripheral and splanchnic arterial vasodilatation and reduced arterial blood pressure and systemic vascular resistance. 3 Portal hypertension and splanchnic vasodilatation are major factors in the development of ascites. 4,5 Secondary to vasodilatation, vasoactive hormones, such as the reninangiotensin-aldosterone system and the sympathetic nervous system, are activated. This leads to renal vasoconstriction and reduced renal perfusion and filtration pressure. The current standard treatment of ascites involves diuretics and paracentesis, which are not designed to improve the underlying pathophysiology. The changes in the renal handling of water and salt seem to develop stepwise from a stage that can be controlled by diuretics to a stage refractory to diuretics and finally to full-blown renal failure, which is known as hepatorenal syndrome (HRS) type 1. 6 Several clinical studies have evaluated the efficacy of the long-term administration of terlipressin [a vasopressin 1 (V1) receptor agonist] in patients with HRS, [7][8][9][10][11][12][13] and there is evidence that terlipressin may improve renal

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Section: Discussionmentioning

confidence: 96%

Terlipressin improves renal function in patients with cirrhosis and ascites without hepatorenal syndrome

et al. 2007

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“…However, Kalambokis et al, 2007 recorded significant decrease in heart rate with treatment with midodrine for 7 days. [19].…”

Section: Discussionmentioning

confidence: 99%

Effect of Midodrine in Patients with Liver Cirrhosis and Refractory Ascites

Obiedallah¹

2017

AJIM

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“…Similarly, Krag and colleagues found that patients with a low cardiac index (< 1.5L/ min/m 2 ) significantly developed more hepatorenal syndrome and had decreased survival rate compared to those with a cardiac index above 1.5 L/min/m 2 [33] . Correspondingly, several studies confirmed this concept by showing that midodrine, an alpha-1 adrenergic agonist, was beneficial in patients with advanced cirrhosis [35][36][37][38][39] . Midodrine therapy increased urinary volume, urinary sodium excretion, blood pressure, and decreased plasma renin activity and overall mortality [39] .…”

Section: Blood Pressure and Cirrhosismentioning

confidence: 98%

Non-Selective Beta-Blockers in Liver Cirrhosis: Friends or Foes? A Review of the Literature

Abboud

Tabet

2016

Journal of Gastroenterology and Hepatology Research

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in cirrhosis, and try to provide logical suggestions concerning the use of this class of medication in patients with cirrhosis. INTRODUCTIONCirrhosis is becoming a leading cause of mortality and morbidity worldwide [1,2] , and since 1981, beta-blockers were found to be highly efficacious in both, primary and secondary prevention of variceal bleeding [3] . Non-selective beta-blockers (NSBB) became the cornerstone of the medical treatment of patients with cirrhosis [3] , and this was demonstrated in several solid studies. However, recent evidence has questioned the use of beta-blockers in patients with end-stage liver disease and refractory ascites [3] . In this article, we are going to review almost all the previous studies about beta-blocker therapy in patients with cirrhosis, and find out the beneficial effects of this therapy, its potential complications and harms, and try to provide suggestions regarding its appropriate use in this specific category of patients. CIRRHOSISCirrhosis represents an advanced stage of progressive hepatic fibrosis characterized by distortion of the hepatic architecture and the formation of regenerative nodules. It is normally considered to be irreversible in its late stages at which point the only therapeutic ABSTRACTCirrhosis has become a leading cause of death in the United States and worldwide owing the increased prevalence of alcoholic liver disease, hepatitis C, and more recently, non-alcoholic steatohepatitis and nonalcoholic fatty liver disease. Beta-blockers have been proven to be efficacious in primary, as long as secondary prophylaxis of variceal bleeding, more than 35 years ago. Nonetheless, recent data has cautioned the use of beta-blockers in patients with end-stage cirrhosis and refractory ascites suggesting increased mortality from betablockers in this group of patients. In this article, we will discuss this topic in details, and review the conflicting studies about beta-blockers REVIEW

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Effects of a 7-day treatment with midodrine in non-azotemic cirrhotic patients with and without ascites

Cited by 68 publications

References 39 publications

Terlipressin improves renal function in patients with cirrhosis and ascites without hepatorenal syndrome

Terlipressin improves renal function in patients with cirrhosis and ascites without hepatorenal syndrome

Effect of Midodrine in Patients with Liver Cirrhosis and Refractory Ascites

Non-Selective Beta-Blockers in Liver Cirrhosis: Friends or Foes? A Review of the Literature

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