title: The effect of 1 month of therapy with midodrine, octreotide-LAR and albumin in refractory ascites: a pilot study.
abstract: BACKGROUND
  The pathogenesis of refractory ascites (RA) is linked to splanchnic vasodilation. We hypothesized that a combination of midodrine, octreotide long-acting release (LAR) and albumin would result in increased natriuresis, better control of ascites and an improvement in renal function in patients with RA+/-Type 2 hepatorenal syndrome.
  
  
  METHODS
  A prospective pilot study in patients with RA as defined by the International Ascites Club. Consecutive patients received an intramuscular injection of octreotide-LAR, 50 g of albumin three times per week and midodrine titrated to increase the systolic blood pressure for 1 month.
  
  
  RESULTS
  Ten patients with RA were enrolled and eight with complete data to 1 month post-treatment were included in the analysis. There was no change in renal function but there was a trend towards a reduction in the volume of ascites removed by paracentesis (P=0.08) and a significant reduction in the plasma renin (P=0.01) and aldosterone concentrations (P=0.01). Interestingly, there was a transient worsening in the model for end-stage liver disease (MELD) score (P=0.01). The deterioration in MELD was completely reversible after discontinuation of therapy.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study of prolonged midodrine, octreotide and albumin therapy in RA. We observed a significant reduction in the plasma renin and aldosterone concentrations and a trend towards a reduction in the volume of ascites removed by paracentesis without an effect on renal function. The beneficial effects are at the expense of a reversible deterioration in the MELD score. Large controlled trials are needed before this therapy can be routinely recommended.
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. ptandon@ualberta.ca
authors.forename: Puneeta
authors.initials: P
authors.lastname: Tandon
authors.forename: Ross T
authors.initials: RT
authors.lastname: Tsuyuki
authors.forename: Lesley
authors.initials: L
authors.lastname: Mitchell
authors.forename: Michael
authors.initials: M
authors.lastname: Hoskinson
authors.forename: Mang M
authors.initials: MM
authors.lastname: Ma
authors.forename: Winnie W
authors.initials: WW
authors.lastname: Wong
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Mason
authors.forename: Klaus
authors.initials: K
authors.lastname: Gutfreund
authors.forename: Vincent G
authors.initials: VG
authors.lastname: Bain
mesh_terms: D000416:Alberta; D000418:Albumins / Q000627:therapeutic use*; D000450:Aldosterone / Q000097:blood; D000704:Analysis of Variance; D001201:Ascites / Q000188:drug therapy*; D003401:Creatine / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D008879:Midodrine / Q000627:therapeutic use*; D015282:Octreotide / Q000627:therapeutic use*; D010865:Pilot Projects; D011446:Prospective Studies; D011863:Radioimmunoassay; D011866:Radioisotope Renography; D012083:Renin / Q000097:blood
chemical_list: D000418:Albumins; D000450:Aldosterone; D008879:Midodrine; D012083:Renin; D003401:Creatine; D015282:Octreotide