Comparative pilot study of repeated large volume paracentesis vs the combination on clonidine-spironolactone in the treatment of cirrhosis-associated refractory ascites.
OBJECTIVE
To study the usefulness of the combination of clonidine--spironolactone in refractory ascites.


METHODS
Twenty cirrhotic patients with refractory ascites were randomly assigned to receive repeated large volume paracentesis plus intravenous albumin (group 1), or a combination of clonidine (0.075 mg twice daily) and spironolactone (200 to 400 mg daily) (group 2).


RESULTS
During the first hospitalisation,, the mean weight loss in group 1 was higher than in group 2 (12.4 +/- 3.2 versus 4.3 +/- 1.1 kg, P < or = 0.01). Mean stay in hospital was shorter in group 2 (20 +/- 1.5 versus 10 +/- 2.8 days; P < or = 0.01). Paracentesis did not induce changes in neuro-hormonal measurements. Oppositely, clonidine induced a decreased sympathetic activity, an increased glomerular filtration rate and a delayed reduction of the renin-aldosterone levels. During the follow-up in group 1, the number of rehospitalisations for ascites was higher than in group 2 (37 versus 3; P < or = 0.01), and the mean time to the first readmission was shorter (10 +/- 2.7 versus 23.7 +/- 5.6 days; P < or = 0.01). The total duration spent in hospital were similar in both groups.


CONCLUSIONS
Paracentesis is more effective for short-term treatment of ascites but clonidine-spironolactone association might provide better long-term control.
Lenaerts
Anne
A
University Department of Hepato-Gastroenterology, CHU de Charleroi, Charleroi, Belgium. anne.lenaerts@chu-charleroi.be
Codden
Thierry
T
Henry
Jean-Pol
JP
Legros
Franz
F
Ligny
Gaston
G
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D001201:Ascites / Q000188:drug therapy* / Q000209:etiology*; D003000:Clonidine / Q000008:administration & dosage / Q000627:therapeutic use*; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000379:methods*; D010359:Patient Readmission; D012008:Recurrence; D013148:Spironolactone / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D000316:Adrenergic alpha-Agonists; D004232:Diuretics; D013148:Spironolactone; D003000:Clonidine