The effect of 1 month of therapy with midodrine, octreotide-LAR and albumin in refractory ascites: a pilot study.
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.
Tandon
Puneeta
P
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. ptandon@ualberta.ca
Tsuyuki
Ross T
RT
Mitchell
Lesley
L
Hoskinson
Michael
M
Ma
Mang M
MM
Wong
Winnie W
WW
Mason
Andrew L
AL
Gutfreund
Klaus
K
Bain
Vincent G
VG
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
D000418:Albumins; D000450:Aldosterone; D008879:Midodrine; D012083:Renin; D003401:Creatine; D015282:Octreotide