Octreotide in liver cirrhosis: a salvage for variceal bleeding can be a gunshot for kidneys.
BACKGROUND
The renal effects of octreotide, used for bleeding esophageal varices in cirrhosis, are controversial.


METHODS
Fourteen cirrhotic patients (Child-Pugh; A/B/C: 1/12/1) were enrolled. Plasma nitrite and endothelin (ET) levels, urinary nitrite output, free water clearance (FWC) and fractional excretion of filtered sodium (FENa) were measured and renal Doppler ultrasound was carried out. Octreotide was infused at a rate of 0.75 microg/kg/h for 3 h after a bolus of 0.75 microg/kg body weight. All the parameters were reevaluated during octreotide administration while the patients acted as their own controls.


RESULTS
Octreotide induced significant reductions in urinary nitrite, FENa and FWC. Plasma ET levels increased (baseline: 6.7 pg/ml, octreotide: 8.4 pg/ml), whereas the plasma nitrite level did not change significantly after octreotide infusion. Overall, no significant change in renal resistive index (RRI) could be demonstrated on Doppler after octreotide administration. However, patients with elevated baseline RRI values had significantly more deterioration in FWC and FENa compared with patients with normal RRI in response to octreotide.


CONCLUSIONS
A marked decrease in FENa, FWC and urinary nitrite output, together with a significant increase in plasma ET level in response to octreotide, may indicate renal dysfunction in cirrhotic patients. This deleterious renal effect of octreotide may be more enhanced in patients with elevated baseline RRI.
Güney Duman
Deniz
D
Subdivision of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey. drduman@excite.com
Tüney
Davut
D
Bilsel
Serpil
S
Benli
Fehime
F
Karan
Sehnaz
S
Avsar
Erol
E
Ozdogan
Osman
O
Tözün
Nurdan
N
D000328:Adult; D000368:Aged; D019332:Endothelin-1 / Q000097:blood; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D007668:Kidney / Q000000981:diagnostic imaging / Q000502:physiology; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009573:Nitrites / Q000097:blood / Q000652:urine; D015282:Octreotide / Q000008:administration & dosage*; D016879:Salvage Therapy; D012964:Sodium / Q000652:urine; D018608:Ultrasonography, Doppler; D014648:Varicose Veins / Q000188:drug therapy* / Q000209:etiology
D019332:Endothelin-1; D005765:Gastrointestinal Agents; D009573:Nitrites; D012964:Sodium; D015282:Octreotide