LONG-TERM ADMINISTRATION OF ISOSORBIDE-5-MONONITRATE DOES NOT IMPAIR RENAL-FUNCTION IN CIRRHOTIC-PATIENTS

Isosorbide-5-mononitrate (Is-5-Mn), alone or combined with beta ers, h as been proposed for prophylaxis of variceal bleeding in cirrhosis. Ho wever, renal insufficiency, might be an important undesirable effect o f this therapy, especially in patients with ascites. We assessed the c hanges in renal function induced in 26 cirrhotic patients by acute or chronic administration of Is-5-Mn, The acute administration of 20 mg o f Is-5-Mn to 21 patients reduced mean blood pressure (83.4 +/- 2.4 vs. 92.8 +/- 3.4 mm Hg, P < .001), urine volume (5.5 +/- 0.8 vs. 8.7 +/- 1.1 mL/min, P < .05), urine sodium excretion (114 +/- 19 vs, 244 +/- 4 1 mu Eq/min, P < .001), urine potassium excretion (41 +/- 3.4 vs, 67 /- 8.5 mu Eq/min, P < .001), and atrial natriuretic factor (74 +/- 10 vs. 98 +/- 12 pg/mL, P < .005). The glomerular filtration rate was dec reased in the 11 patients with ascites (57 +/- 9 vs, 68 +/- 12 mL/min, P < .05), and plasma renin activity was increased in 4 ascitics. Twen ty-one patients (16 from the acute study + 5 other patients) were give n Is-5-Mn for 3 months at the dose of 80 mg/d. This did not affect blo od pressure and renal function in patients without ascites, but reduce d mean blood pressure (91.9 +/- 3.4 vs. 89.6 +/- 3 mm Hg, P < .05), ur ine volume (5.8 +/- 1.1 vs. 3.4 +/- 0.9 mL/min, P < .05), and urine so dium excretion (205 +/- 38 vs. 99 +/- 16 mu Eq/min, P < .01) in those with ascites. There were no changes in glomerular filtration rate and renal plasma now, while plasma renin activity increased in only 3 pati ents with ascites and 1 without, Sy Systemic hemodynamics and renal fu nction of cirrhotic patients, especially those with ascites, are affec ted adversely by acute administration of Is-5-Mn. Long-term administra tion of the drug is well tolerated by compensated patients and does no t affect renal plasma now nor glomerular filtration rate, but can indu ce hypotension and sodium retention in patients with ascites.