Journal of Hepatology
Volume 39, Issue 2 , Pages 187-192 , August 2003

Spironolactone alone or in combination with furosemide in the treatment of moderate ascites in nonazotemic cirrhosis. A randomized comparative study of efficacy and safety

  • Justiniano Santos

      Affiliations

    • Department of Gastroenterology, Hospital Universitari Germans Trı́as i Pujol, Carretera del Canyet, s/n, 08916 Badalona, Spain
    • ,
  • Ramon Planas

      Affiliations

    • Department of Gastroenterology, Hospital Universitari Germans Trı́as i Pujol, Carretera del Canyet, s/n, 08916 Badalona, Spain
    • Corresponding Author InformationCorresponding author. Tel./fax: +34-93-497-8951
    • ,
  • Albert Pardo

      Affiliations

    • Department of Gastroenterology, Hospital Universitario de Canarias, Tenerife, Spain
    • ,
  • Rosa Durández

      Affiliations

    • Department of Gastroenterology, Hospital Universitari Germans Trı́as i Pujol, Carretera del Canyet, s/n, 08916 Badalona, Spain
    • ,
  • Eduard Cabré

      Affiliations

    • Department of Gastroenterology, Hospital Universitari Germans Trı́as i Pujol, Carretera del Canyet, s/n, 08916 Badalona, Spain
    • ,
  • Rosa Maria Morillas

      Affiliations

    • Department of Gastroenterology, Hospital Universitari Germans Trı́as i Pujol, Carretera del Canyet, s/n, 08916 Badalona, Spain
    • ,
  • Maria Luisa Granada

      Affiliations

    • Department of Biochemistry, Hospital Universitari Germans Trı́as i Pujol, 08916 Badalona, Spain
    • ,
  • José Angel Jiménez

      Affiliations

    • Department of Radiology, Hospital Universitari Germans Trı́as i Pujol, 08916 Badalona, Spain
    • ,
  • Enrique Quintero

      Affiliations

    • Department of Gastroenterology, Hospital Universitario de Canarias, Tenerife, Spain
    • ,
  • Miquel Angel Gassull

      Affiliations

    • Department of Gastroenterology, Hospital Universitari Germans Trı́as i Pujol, Carretera del Canyet, s/n, 08916 Badalona, Spain

Received 18 June 2002 ,Revised 18 March 2003 ,Accepted 1 April 2003.

References 

  1. Arroyo V, Ginès V, Planas R, Panés J, Rodés J. Management of patients with cirrhosis and ascites. Semin Liver Dis. 1986;6:353–369
  2. Ginès P, Quintero E, Arroyo V, Terés J, Bruguera M, Rimola A, et al.  Compensated cirrhosis: natural history and prognostic factors. Hepatology. 1987;7:122–128
  3. Schrier RW, Arroyo V, Bernardi M, Epstein M, Henriksen JH, Rodés J. Peripheral arterial vasodilation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology. 1988;8:1151–1157
  4. Arroyo V, Ginès P. Arteriolar vasodilatation and the pathogenesis of the hyperdynamic circulation and renal sodium and water retention in cirrhosis. Gastroenterology. 1992;102:1077–1079
  5. Gatta A, Angeli P, Caregaro L, Menon F, Sacerdoti D, Merkel C. A pathophysiological interpretation of unresponsiveness to spironolactone in a stepped-care approach to the diuretic treatment of ascites in nonazotemic cirrhotic patients. Hepatology. 1991;14:231–236
  6. Perez-Ayuso RM, Arroyo V, Planas R, Gaya J, Bory F, Rimola A, et al. Randomized comparative study of efficacy of furosemide versus spironolactone in nonazotemic cirrhosis with ascites. Gastroenterology. 1983;84:961–968
  7. Arroyo V, Ginès P, Planas R, Jiménez W, Rodés J. Ascites and renal dysfunction in cirrhosis. In:  Bircher J,  Benhamou JP,  McIntyre N,  Rizzeto M,  Rodés J editor. Oxford textbook of clinical hepatology. vol. I:Oxford: Oxford University Press; 1999;p. 697–761
  8. Angeli P, Gatta A. Medical treatment of ascites in cirrhosis. In:  Arroyo V,  Ginès P,  Rodés J,  Schrier RW editor. Ascites and renal dysfunction in liver disease. Oxford: Blackwell Science; 1999;p. 442–462
  9. Bernardi M, Laffi G, Salvagnini M, Azzena G, Bonato S, Marra F, et al.  Efficacy and safety of the stepped care medical treatment of ascites in liver cirrhosis: a randomized controlled clinical trial comparing two diets with different sodium content. Liver. 1993;13:156–162
  10. Fogel MR, Sawhney VK, Neal EA, Miller RG, Knauer CM, Gregory PB. Diuresis in the ascitic patient: a randomized controlled trial of three regimens. J Clin Gastroenterol. 1981;3 Suppl 1:73–80
  11. Asbert M, Jiménez W, Gaya J, Ginès P, Arroyo V, Rivera F, et al. Assessment of the renin-angiotensin system in cirrhotic patients. J Hepatol. 1992;15:179–183
  12. Ginès P, Jiménez W, Arroyo V, Navasa M, López C, Titó LL, et al.  Atrial natriuretic factor in cirrhosis with ascites: plasma levels, cardiac release and splanchnic extraction. Hepatology. 1988;8:636–642
  13. Inadomi J, Cello J, Koch J. Ultrasonographic determination of ascitic volume. Hepatology. 1996;24:549–551
  14. Arroyo V, Ginès P, Gerbes A, Dudley F, Gentilini P, Laffi G, et al.  Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. Hepatology. 1996;23:164–176
  15. Ginès P, Arroyo V, Rodés J. Pharmacotherapy of ascites associated with cirrhosis. Drugs. 1992;43:316–332
  16. Angeli P, Gatta A, Caregaro L, Menon F, Sacerdoti D, Merkel C, et al. Tubular site of renal sodium retention in ascitic liver cirrhosis evaluated by lithium clearance. Eur J Clin Invest. 1990;20:111–117
  17. Angeli P, Caregaro L, Menon F, Sacerdoti D, De Toni R, Merkel C, et al. Variability of atrial natriuretic peptide plasma levels in ascitic cirrhotics: pathophysiological and clinical implications. Hepatology. 1992;16:1389–1394
  18. Wong F, Tobe S, Legault L, Logan AG, Skorecki K, Blendis L. Refractory ascites in cirrhosis: roles of volume expansion and plasma atrial natriuretic factor level elevation. Hepatology. 1993;18:519–528
  19. Wilkinson SP, Williams R. Ascites, electrolyte disorders and renal failure. In:  Wright R,  Alberti KGMM,  Karran S,  Millward-Sadler GH editor. Liver and biliary disease. Philadelphia, PA: Saunders; 1979;p. 1060–1086
  20. Bernardi M, Santini C, Trevisani F, Baraldini M, Ligabue A, Gasbarrini G. Renal function impairment induced by change in posture in patients with cirrhosis and ascites. Gut. 1985;26:629–635
  21. Arroyo V, Bosch J, Mauri M. Renin, aldosterone and renal hemodynamics in cirrhosis with ascites. Eur J Clin Invest. 1979;9:69–73
  22. Stanley MM, Ochi S, Lee KK, Nemchausky BA, Greenlee HB, Allen JI, et al.  Peritoneovenous shunting as compared with medical treatment in patients with alcoholic cirrhosis and massive ascites. N Engl J Med. 1989;321:1632–1638
  23. Arroyo V, Epstein M, Gallus G. Refractory ascites in cirrhosis. Mechanism and management. Gastroenterol Int. 1989;2:195–207
  24. Sherlock S, Senewiratne B, Scott A, Walker JG. Complications of diuretic therapy in hepatic cirrhosis. Lancet. 1966;1:1049–1053
  25. Strauss E, De Sa MG, Lacet CMC, Cartapatti Da Silva E, Dos Santos WR, Honain NZ, et al. Standardization of a therapeutic approach for ascites due to chronic liver disease. A prospective study of 100 cases. Gastroenterol Endosc Digest. 1985;4:79–86
  26. Ginès P, Arroyo V, Quintero E, Planas R, Bory F, Cabrera J, et al.  Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites. Results of a randomized study. Gastroenterology. 1987;93:234–241

☆ Preliminary results of this study were presented at the 50th Annual Meeting of the American Association for the Study of Liver diseases held in Dallas (November, 1999) and the 35th Annual Meeting of the European Association for the Study of the Liver held in Rotterdam (April–May, 2000).

☆☆ The authors who have taken part in this study have not a relationship with the manufacturers of the drugs involved either in the past or present and did not receive funding from the manufacturers to carry out their research.

PII: S0168-8278(03)00188-0

doi: 10.1016/S0168-8278(03)00188-0

Journal of Hepatology
Volume 39, Issue 2 , Pages 187-192 , August 2003

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