The effects of chronic treatment with octreotide versus octreotide plus midodrine on systemic hemodynamics and renal hemodynamics and function in nonazotemic cirrhotic patients with ascites.
OBJECTIVE
The adrenergic agonist midodrine improved circulatory and renal dysfunction when acutely administered in nonazotemic cirrhotic patients with ascites while its combination with octreotide has recently been proposed as an effective treatment of type 1 hepatorenal syndrome (HRS). However, the effects of octreotide on systemic hemodynamics and renal function in cirrhotic patients are controversial. This study evaluated the effects of chronic treatment with octreotide versus octreotide plus midodrine on systemic hemodynamics and renal hemodynamics, and function in nonazotemic cirrhotic patients with ascites.


METHODS
Twenty-five patients were studied at baseline and 11 days after administration of subcutaneous octreotide 300 mug, b.i.d. alone (n = 12) or together with oral midodrine 7.5 mg, t.i.d. (n = 13).


RESULTS
Octreotide did not improve systemic hemodynamics whereas the addition of midodrine significantly decreased cardiac index (CI) and heart rate (HR), and increased mean arterial pressure (MAP) and systemic vascular resistance (SVR). Octreotide caused a decrease in renal vascular resistance (RVR) and increased renal blood flow (RBF) but significantly reduced glomerular filtration rate. The association of midodrine to octreotide did not modify renal hemodynamics and function as compared to baseline while it caused an almost significant minor increase in RVR and a significant minor decrease in RBF as compared to octreotide alone. Consequently, a significant minor increase in glomerular filtration rate was demonstrated. The plasma values of active renin, aldosterone, and glucagon were significantly reduced in either group.


CONCLUSIONS
Octreotide does not improve systemic hemodynamics in nonazotemic cirrhotic patients with ascites while it impairs renal function. On the other hand, the addition of midodrine can ameliorate the hyperdynamic circulation without inducing renal dysfunction in these patients.
Kalambokis
Georgios
G
Department of Internal Medicine, Medical School, Ioannina, Greece.
Economou
Michalis
M
Fotopoulos
Andreas
A
Al Bokharhii
Jihad
J
Pappas
Christos
C
Katsaraki
Afroditi
A
Tsianos
Epameinondas V
EV
D000284:Administration, Oral; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D001783:Blood Flow Velocity / Q000187:drug effects; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D005934:Glucagon / Q000097:blood; D006439:Hemodynamics / Q000187:drug effects*; D006530:Hepatorenal Syndrome / Q000188:drug therapy*; D006801:Humans; D007279:Injections, Subcutaneous; D007668:Kidney / Q000098:blood supply*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000008:administration & dosage*; D015282:Octreotide / Q000008:administration & dosage*; D012039:Regional Blood Flow / Q000187:drug effects; D012083:Renin / Q000097:blood; D014655:Vascular Resistance / Q000187:drug effects
D000316:Adrenergic alpha-Agonists; D000450:Aldosterone; D008879:Midodrine; D005934:Glucagon; D012083:Renin; D015282:Octreotide