Albumin improves the response to diuretics in patients with cirrhosis and ascites: results of a randomized, controlled trial - PubMed (original) (raw)

Clinical Trial

Albumin improves the response to diuretics in patients with cirrhosis and ascites: results of a randomized, controlled trial

P Gentilini et al. J Hepatol. 1999 Apr.

Abstract

Background/aims: Diuretic treatment of ascites could result in intravascular volume depletion, electrolyte imbalance and renal impairment. We investigated whether intravascular volume expansion with albumin exert beneficial effects in cirrhosis with ascites.

Methods: In protocol 1, 126 cirrhotic inpatients in whom ascites was not relieved following bed rest and a low-sodium diet, were randomly assigned to receive diuretics (group A) or diuretics plus albumin, 12.5 g/day (group B). In protocol 2, group A patients continued to receive diuretics and group B diuretics plus albumin (25 g/week) as outpatients and were followed up for 3 years. End points were: disappearance of ascites, duration of hospital stay (protocol 1), recurrence of ascites, hospital readmission and survival (protocol 2).

Results: The cumulative rate of response to diuretic treatment of ascites was higher (p < 0.05) and hospital stay was shorter (20 +/- 1 versus 24 +/- 2 days, p < 0.05) in group B than in group A patients. After discharge, group B patients had a lower cumulative probability of developing ascites (19%, 56%, 69% versus 30%, 79% and 82% at 12, 24 and 36 months, p < 0.02) and a lower probability of readmission to the hospital (15%, 56%, 69% versus 27%, 74% and 79%, respectively, p < 0.02). Survival was similar in the two groups.

Conclusions: Albumin is effective in improving the rate of response and preventing recurrence of ascites in cirrhotic patients with ascites receiving diuretics. However, the cost/benefit ratio was favorable to albumin in protocol 1 but not in protocol 2.

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Comment in

Intravenous albumin with diuretics: protean lessons to be learnt?
Blendis L, Wong F. Blendis L, et al. J Hepatol. 1999 Apr;30(4):727-30. doi: 10.1016/s0168-8278(99)80207-4. J Hepatol. 1999. PMID: 10207818 No abstract available.
Albumin substitution improves urinary sodium excretion and diuresis in patients with liver cirrhosis and refractory ascites.
Schindler C, Ramadori G. Schindler C, et al. J Hepatol. 1999 Dec;31(6):1132. doi: 10.1016/s0168-8278(99)80329-8. J Hepatol. 1999. PMID: 10604590 No abstract available.

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Albumin improves the response to diuretics in patients with cirrhosis and ascites: results of a randomized, controlled trial - PubMed (original) (raw)