The effect of 1 month of therapy with midodrine, octreotide-LAR and albumin in refractory ascites: A pilot study

Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Liver international: official journal of the International Association for the Study of the Liver (Impact Factor: 4.85). 06/2008; 29(2):169-74. DOI: 10.1111/j.1478-3231.2008.01778.x
Source: PubMed


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.
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.
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.
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.

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    • "Earlier studies evaluating midodrine [20] or midodrine plus octreotide [19] in nonazotemic cirrhotics did not show a significant change in hepatic function. However, in a recent pilot study, there was a significant deterioration in the MELD score during treatment with midodrine [22]. "
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