Effects of "body compression" on parameters related to ascites formation: therapeutic trial in cirrhotic patients

Abstract

Decreased effective circulating blood volume is an important factor in ascites formation in liver cirrhosis. We designed a "body compression" apparatus as a means to restore effective blood volume and investigated its effectiveness in reducing ascites formation in cirrhotics in terms of its effect on parameters of ascites formation noted below. The subjects, eight cirrhotics with ascites and eight cirrhotics without ascites were given spironolactone (50-75 mg/day) and furosemide (40-80 mg/day) while they received a diet containing 85 mEq of sodium per day. All four limbs and the lower abdomen were compressed with constant pressure [height (cm) divided by 13.6 mmHg] once, for 3h, using stroke rehabilitation splints, while patients lay supine. In cirrhotics both with and without ascites, urine volume, urinary sodium excretion, and creatinine clearance during the body compression were greater than values during control (non-compression) periods (urine volume, means 285 vs 169 ml/3h; P < 0.001, urinary sodium excretion 15.8 vs 9.5 mEq/3h; p < 0.001, creatinine clearance 74 vs 59 ml/min, P < 0.001, respectively). The increased basal plasma renin activity, angiotensin II, aldosterone, and norepinephrine levels in all cirrhotics were significantly decreased by the body compression. In another group of six cirrhotics who received no diuretics or albumin, repeat body compression alleviated ascites in three with well preserved renal function, but was ineffective in three with markedly impaired renal function. These results suggest that the improvement in renal function brought about by the body compression is attributable to an increase in effective circulating blood volume. This maneuver may be a useful complementary therapy in patients with cirrhotic ascites with well preserved renal function.

Tolvaptan for improvement of hepatic edema: A phase 3, multicenter, randomized, double‐blind, placebo‐controlled trial

“…This trial enrolled liver cirrhosis patients with ascites who had been receiving combination therapies with a loop diuretic and an anti‐aldosterone agent from at least 7 days prior to acquisition of informed consent. Standard daily dose of concomitant diuretics in Japan was as follows: a loop diuretic at a daily dose equivalent to furosemide 40 mg/day or higher and spironolactone at 25 mg/day or higher, or a loop diuretic at a daily dose equivalent to furosemide 20 mg/day or higher and spironolactone at 50 mg/day or higher . Patients, aged 20–80 years, were required to be hospitalized or to be available for hospitalization during the trial period.…”

Dose‐finding trial of tolvaptan in liver cirrhosis patients with hepatic edema: A randomized, double‐blind, placebo‐controlled trial

“…If the daily dose of furosemide and other loop diuretics were at least 40 mg and equivalent to 40 mg furosemide, respectively, then the daily dose of spironolactone was set at 25 mg. If the daily dose of spironolactone was at least 50 mg, then the daily dose of furosemide and other loop diuretics were set at 20 mg or equivalent to 20 mg furosemide, respectively …”

“…If the daily dose of spironolactone was at least 50 mg, then the daily dose of furosemide and other loop diuretics were set at 20 mg or equivalent to 20 mg furosemide, respectively. 18 Patients who met the following criteria were randomized to one of the trial groups and allowed to advance to the treatment period to evaluate efficacy of the drug: patients with ascites during pretreatment observation period; patients orally treated with conventional diuretics without change in dose or mode of administration from 7 days before start of trial drug administration until final day of pretreatment observation period; patients with stable bodyweight (11.0 kg) for 2 days before start of trial drug administration.…”