The management of ascites in cirrhosis: Report on the consensus conference of the International Ascites Club

Moore, Kevin; Wong, Florence; Ginès, Pere; Bernardi, Mauro; Ochs, Andreas; Salerno, Francesco; Angeli, Paolo; Porayko, Michael K.; Moreau, Richard; Garcia-Tsao, G.; Jiménez, Wladimiro; Planas, Ramón; Arroyo, Vicente

doi:10.1053/jhep.2003.50315

Cited by 787 publications

(742 citation statements)

References 61 publications

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“…Sodium restriction and diuresis are recommended as initial therapy based on their efficacy in the management of ascites [4,21]. TIPS has been shown to be effective in preventing reaccumulation of pleural effusion in patients who are refractory to diuretics and in decreasing mortality.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of patients with chest tube insertion for hepatic hydrothorax

Orman

Lok

2009

Hepatol Int

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Purpose Case reports and small case series have reported a high rate of complications associated with chest tube placement for hepatic hydrothorax. We describe the inhospital and 3-month outcomes of patients who have had this procedure. Methods A retrospective medical record review was performed of all patients admitted to a tertiary care center over a 10-year period with a chest tube placed for hepatic hydrothorax. Demographic data and outcomes were collected and analyzed. Results Seventeen patients were identified; 12 were taking diuretics and 8 were taking multiple diuretics at the time of admission. MELD score was 14 (range = 7-34). During hospitalization, 16 had at least 1 and 12 had more than 1 complications. The most common complications were acute kidney injury (n = 11), pneumothorax (n = 7), and empyema (n = 5). Two patients died during the index admission and four others within 3 months of that admission. Six of seven patients who received TIPS survived. Conclusions Chest tube insertion for hepatic hydrothorax carries significant morbidity and mortality, with questionable benefit.

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Section: Discussionmentioning

confidence: 99%

Outcomes of patients with chest tube insertion for hepatic hydrothorax

Orman

Lok

2009

Hepatol Int

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“…Refractory ascites was defined by the diagnostic criteria set by the International Ascites Club, 15 which are in brief as follows: ascites that cannot be mobilized or early recurrence that cannot be satisfactorily prevented by medical therapy. All patients with nonrefractory ascites had visible ascites verified by an abdominal ultrasound examination within the 2 months before the investigation.…”

Section: Methodsmentioning

confidence: 99%

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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“…Diuretics were only given if they produced a significant effect on urine sodium (>30 mEq/day) and were not associated with side effects. 19 Large ascites was treated with repeated large-volume paracentesis with IV albumin. Norfloxacin was given to patients with low protein concentration in the ascitic fluid and those with previous episodes of spontaneous bacterial peritonitis.…”

Section: Management Before and After Ltmentioning

confidence: 99%

Treatment of type 2 hepatorenal syndrome in patients awaiting transplantation: Effects on kidney function and transplantation outcomes

et al. 2015

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There is little information on the effects of treatment with vasoconstrictors plus albumin in patients with type 2 hepatorenal syndrome (HRS), particularly those awaiting liver transplantation (LT). This study reports the effects of treatment of type 2 HRS in patients on the waiting list for LT. We included 56 patients with type 2 HRS who were awaiting LT. Out of these 56 patients, 31 were treated with terlipressin and albumin. Nineteen (61%) of these 31 patients had response to therapy, and 11 of them relapsed after treatment withdrawal. There were no differences in mortality on the waiting list between responders and nonresponders. Among the 46 (82%) patients who underwent transplantation, 15 underwent transplantation with reversal of type 2 HRS, whereas the remaining 31 underwent transplantation with type 2 HRS. There were no significant differences in serum creatinine or estimated glomerular filtration rate between the 2 cohorts of patients at 3, 6, and 12 months after transplantation. There were no significant differences regarding development of acute kidney injury, need for renal replacement therapy, frequency of chronic kidney disease 1 year after transplant, length of hospitalization, and survival. In conclusion, treatment of patients with type 2 HRS with terlipressin and albumin does not appear to have beneficial effects either in pretransplantation or in posttransplantation outcomes.

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The management of ascites in cirrhosis: Report on the consensus conference of the International Ascites Club

Cited by 787 publications

References 61 publications

Outcomes of patients with chest tube insertion for hepatic hydrothorax

Outcomes of patients with chest tube insertion for hepatic hydrothorax

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

Treatment of type 2 hepatorenal syndrome in patients awaiting transplantation: Effects on kidney function and transplantation outcomes

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