DIURETIC REQUIREMENTS AFTER THERAPEUTIC PARACENTESIS IN NON-AZOTEMIC PATIENTS WITH CIRRHOSIS - A RANDOMIZED DOUBLE-BLIND TRIAL OF SPIRONOLACTONE VERSUS PLACEBO

Backgrounds/Aims: Diuretic requirements after mobilization of ascites by paracentesis have never been assessed in cirrhosis, It is also unkn own whether diuretics increase the incidence of postparacentesis circu latory dysfunction, The aim of this study was to investigate these fea tures and to assess whether measurement of plasma renin activity and a ldosterone prior to paracentesis predicts diuretic response after this procedure. Methods: Thirty-six patients with non-azotemic cirrhosis a nd ascites treated by total paracentesis plus i.v. albumin were random ly assigned to receive placebo (n=17) or spironolactone 225 mg/day (n= 19) immediately after paracentesis and followed-up for 4 weeks. Result s: Five patients (three in the placebo and two in the spironolactone g roup) abandoned the treatment prior to ascites recurrence or the end o f the study due to complications or lack of compliance, The analysis w as performed in the remaining 31 patients, Ascites recurrence was more common in the placebo group (13 cases, 93%) than in the spironolacton e group (3 cases, 18%) (p<0.0001) and occurred within the first 2 week s of follow-up in more than 50% of patients. Patients developing ascit es in the spironolactone group had higher levels of renin (14.1, 20.6, 32.4 ng/ml per h) and aldosterone (120, 149, 288 ng/dl) than those wh o did not develop ascites (renin: 2.0+/-2.1 ng/ml per h; range 0.1-6.8 ; aldosterone: 43+/-38 ng/dl; range 4-116), Three patients in the plac ebo group and two in the spironolactone group developed postparacentes is circulatory dysfunction (defined as an increase in renin at the thi rd day after paracentesis greater than 50% over baseline levels up to a value higher than 4 ng/ml per h). Conclusions: Patients with cirrhos is treated by paracentesis should receive diuretics immediately after this procedure to prevent early recurrence of ascites, The administrat ion of 225 mg/day of spironolactone is a good empiric treatment for no n-azotemic patients with cirrhosis, because it is effective in most ca ses and does not increase the incidence of postparacentesis circulator y dysfunction, The determination of plasma levels of renin or aldoster one prior to paracentesis predicts the efficacy of spironolactone in t he prevention of ascites recurrence.