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

• Published in: Liver international Vol. 29; no. 2; pp. 169 - 174
• Main Authors: Tandon, Puneeta, Tsuyuki, Ross T., Mitchell, Lesley, Hoskinson, Michael, Ma, Mang M., Wong, Winnie W., Mason, Andrew L., Gutfreund, Klaus, Bain, Vincent G.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.02.2009
• Subjects: Alberta; albumin; Albumins - therapeutic use; Aldosterone - blood; Analysis of Variance; ascites; Ascites - drug therapy; Creatine - pharmacokinetics; Female; hepatorenal syndrome; Humans; Male; Metabolic Clearance Rate; Middle Aged; midodrine; Midodrine - therapeutic use; octreotide; Octreotide - therapeutic use; Pilot Projects; Prospective Studies; Radioimmunoassay; Radioisotope Renography; refractory ascites; Renin - blood; Alberta
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/j.1478-3231.2008.01778.x

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.