PREDICTIVE FACTORS INFLUENCING THE THERAPEUTIC RESPONSE TO DIURETIC TREATMENT OF ASCITES IN NONAZOTEMIC CIRRHOTIC-PATIENTS

Background: A low-sodium diet and diuretics, although widely used, are not always the most satisfactory therapy for treatment of ascites in nonazotemic patients with liver cirrhosis. The objective of this inves tigation was to analyze various predictive factors influencing the the rapeutic response to diuretic treatment of ascites in these patients. Methods: Twenty-seven patients with nonazotemic liver cirrhosis and as cites were initially treated with spironolactone, 200 mg/day. If no re sponse was observed, furosemide was added at 40-120 mg/day. Before and during the diuretic therapy 30 clinical and laboratory variables were investigated as possible predictive factors influencing the therapeut ic response to diuretics. The renal arterial resistive index (RI) (ref lecting renal vascular resistance) was estimated with duplex Doppler u ltrasonography. Results: Sixteen of the 27 patients (59%) responded to spironolactone alone, whereas 6 patients (22%) responded to combined diuretic therapy with spironolactone and furosemide. Five patients (19 %) did not respond to diuretic treatment. Eight of the 30 variables an alyzed were statistically significant as possible predictive factors i nfluencing the diuretic response: previous episodes of ascites and gas trointestinal hemorrhage, the presence of peripheral edema, the amount of ascites, plasma renin activity,plasma aldosterone concentrations, urinary sodium excretion, and renal interlobar arterial RI. In all pat ients who had diuretic-resistant ascites, renal interlobar arterial RI was greater than 0.70. Only 9% of patients who responded satisfactori ly to diuretic therapy had interlobar arterial RI greater than 0.70. C onclusions: According to our results. consideration for combining the clinical findings with noninvasively measured renal arterial RI using duplex Doppler ultrasonography would be mandatory in identifying a sub group of cirrhotic patients with ascites who are at high risk for diur etic unresponsiveness.