Effects of "body compression" on parameters related to ascites formation: therapeutic trial in cirrhotic patients

Decreased effective circulating blood volume is an important factor in asci tes formation in liver cirrhosis. We designed a "body compression" apparatu s as a means to restore effective blood volume and investigated its effecti veness in reducing ascites formation in cirrhotics in terms of its effect o n parameters of ascites formation noted below. The subjects, eight cirrhoti cs with ascites and eight cirrhotics without ascites were given spironolact one (50-75 mg/day) and furosemide (40-80 mg/day) while they received a diet containing 85 mEq of sodium per day. All four limbs and the lower abdomen were compressed with constant pressure [height (cm) divided by 13.6 mmHg] o nce, for 3 h, using stroke rehabilitation splints, while patients lay supin e. In cirrhotics both with and without ascites, urine volume, urinary sodiu m excretion, and creatinine clearance during the body compression were grea ter than values during control (non-compression) periods (urine volume, mea ns 285 vs 169 ml/3 h; P < 0.001, urinary sodium excretion 15.8 vs 9.5 mEq/3 h; p < 0.001, creatinine clearance 74 vs 59 ml/min, P < 0.001, respectivel y). The increased basal plasma renin activity, angiotensin III aldosterone, and norepinephrine levels in all cirrhotics were significantly decreased b y the body compression. In another group of six cirrhotics who received no diuretics or albumin, repeat body compression alleviated ascites in three w ith well preserved renal function, but was ineffective in three with marked ly impaired renal function. These results suggest that the improvement in r enal function brought about by the body compression is attributable to an i ncrease in effective circulating blood volume. This maneuver may be a usefu l complementary therapy in patients with cirrhotic ascites with well preser ved renal function.