Renal effects of treatment with diuretics, octreotide or both, in non-azotemic cirrhotic patients with ascites.
BACKGROUND
Diuretic-induced hyperreninaemia is associated with renal dysfunction in cirrhotic patients with ascites, and in turn prevents the use of high doses of diuretics. Furthermore, ample evidence suggests that octreotide can inhibit the activation of the renin-aldosterone axis. The present study investigated the renal effects of the addition of octreotide to furosemide and spironolactone in the treatment of non-azotemic cirrhotic patients with ascites.


METHODS
We studied 20 patients treated with furosemide and spironolactone. Of them, 10 (Group 1) discontinued diuretic treatment for 7 days. Thereafter, for 5 days each patient received subcutaneous octreotide 300 microg b.i.d., in 10 patients (Group 2) in addition to their usual diuretics. We collected data on the patients while they received diuretics (both groups), after discontinuation of diuretics (Group 1), and after octreotide administration (both groups).


RESULTS
We observed a trend to increase creatinine clearance and a significant reduction in plasma active renin and plasma aldosterone after the discontinuation of diuretics. The subsequent introduction of octreotide reduced glomerular filtration rate, although it significantly decreased plasma active renin and plasma aldosterone. In contrast, the addition of octreotide to diuretic treatment significantly increased glomerular filtration rate, urine volume and sodium excretion. The magnitudes of the decreases in plasma-active renin and aldosterone produced by the combination of octreotide and diuretics were similar to those produced by octreotide alone or by the discontinuation of diuretics.


CONCLUSIONS
Octreotide alone does not improve renal function in cirrhotic patients with ascites. On the contrary, adding it to diuretic treatment increases glomerular filtration rate and sodium and water excretion, mainly through the suppression of an activated renin-aldosterone axis.
Kalambokis
Georgios
G
Department of Internal Medicine, Medical School of Ioannina, 45110 Ioannina, Greece.
Economou
Michalis
M
Fotopoulos
Andreas
A
Bokharhii
Jihad Al
JA
Katsaraki
Afroditi
A
Tsianos
Epameinondas V
EV
D000328:Adult; D000368:Aged; D002915:Chylous Ascites / Q000188:drug therapy* / Q000652:urine; D004232:Diuretics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007279:Injections, Subcutaneous; D007668:Kidney / Q000187:drug effects*; D007677:Kidney Function Tests; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000652:urine; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D012964:Sodium / Q000378:metabolism; D013148:Spironolactone / Q000627:therapeutic use; D014867:Water / Q000378:metabolism
D004232:Diuretics; D005765:Gastrointestinal Agents; D014867:Water; D013148:Spironolactone; D005665:Furosemide; D012964:Sodium; D015282:Octreotide