NDT Advance Access originally published online on May 10, 2005
Nephrology Dialysis Transplantation 2005 20(8):1623-1629; doi:10.1093/ndt/gfh871
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Renal effects of treatment with diuretics, octreotide or both, in non-azotemic cirrhotic patients with ascites
1 Department of Internal Medicine, 2 Department of Gastroenterology, 3 Department of Nuclear Medicine and 4 Department of Statistics, Medical School, Ioannina, Greece
Correspondence and offprint requests to: Dr Epameinondas V. Tsianos, Professor of Medicine, Department of Internal Medicine, Medical School of Ioannina, 45110 Ioannina, Greece. Email: geodora{at}mail.gr
Background. Diuretic-induced hyperreninaemia is associated with renal dysfunction in cirrhotic patients with ascites, and in turn prevents the use of high doses of diuretics. Furthermore, ample evidence suggests that octreotide can inhibit the activation of the renin–aldosterone axis. The present study investigated the renal effects of the addition of octreotide to furosemide and spironolactone in the treatment of non-azotemic cirrhotic patients with ascites.
Methods. We studied 20 patients treated with furosemide and spironolactone. Of them, 10 (Group 1) discontinued diuretic treatment for 7 days. Thereafter, for 5 days each patient received subcutaneous octreotide 300 µg b.i.d., in 10 patients (Group 2) in addition to their usual diuretics. We collected data on the patients while they received diuretics (both groups), after discontinuation of diuretics (Group 1), and after octreotide administration (both groups).
Results. We observed a trend to increase creatinine clearance and a significant reduction in plasma active renin and plasma aldosterone after the discontinuation of diuretics. The subsequent introduction of octreotide reduced glomerular filtration rate, although it significantly decreased plasma active renin and plasma aldosterone. In contrast, the addition of octreotide to diuretic treatment significantly increased glomerular filtration rate, urine volume and sodium excretion. The magnitudes of the decreases in plasma-active renin and aldosterone produced by the combination of octreotide and diuretics were similar to those produced by octreotide alone or by the discontinuation of diuretics.
Conclusions. Octreotide alone does not improve renal function in cirrhotic patients with ascites. On the contrary, adding it to diuretic treatment increases glomerular filtration rate and sodium and water excretion, mainly through the suppression of an activated renin–aldosterone axis.
Keywords: ascites; cirrhosis; diuretic treatment; octreotide; renal function