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

Liver Int. 2009 Feb;29(2):169-74. doi: 10.1111/j.1478-3231.2008.01778.x. Epub 2008 May 19.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alberta
  • Albumins / therapeutic use*
  • Aldosterone / blood
  • Analysis of Variance
  • Ascites / drug therapy*
  • Creatine / pharmacokinetics
  • Female
  • Humans
  • Male
  • Metabolic Clearance Rate
  • Middle Aged
  • Midodrine / therapeutic use*
  • Octreotide / therapeutic use*
  • Pilot Projects
  • Prospective Studies
  • Radioimmunoassay
  • Radioisotope Renography
  • Renin / blood

Substances

  • Albumins
  • Aldosterone
  • Midodrine
  • Renin
  • Creatine
  • Octreotide