Relationships between haemodynamic alterations and the development of ascites or refractory ascites in patients with cirrhosis

Objective In patients with cirrhosis, the relationships between haemodynami c alterations and the development of ascites or the occurrence of refractor y ascites are unknown. The aim of the present study was to compare haemodyn amic measurements obtained in patients with non-refractory ascites to haemo dynamic measurements obtained in patients without ascites and in patients w ith refractory ascites. Methods A cohort of 121 patients was prospectively studied, of whom 29 pati ents did not have ascites, 45 had non-refractory ascites and 47 had refract ory ascites. Splanchnic, renal and systemic haemodynamics were measured in all patients. Results The hepatic venous pressure gradient was significantly higher in pa tients with non-refractory ascites than in patients without ascites (18.5 /- 0.8 mmHg versus 15.8 +/- 0.7 mmHg). Renal and systemic haemodynamics did not significantly differ between patients with nonrefractory ascites and p atients without ascites. The glomerular filtration rate and renal blood flo w were significantly lower in patients with refractory ascites than in pati ents with non-refractory ascites (77 +/- 4 versus 107 +/- 5 ml/min and 867 +/- 62 versus 1008 +/- 68 ml/min, respectively). Splanchnic and systemic ha emodynamics did not significantly differ between patients with refractory a scites and patients with non-refractory ascites. Conclusions In patients with cirrhosis, an increase in portal hypertension was the sole haemodynamic alteration related to the development of ascites. Renal vasoconstriction (and subsequent renal hypoperfusion and hypofiltrat ion) was the only haemodynamic alteration related to the occurrence of refr actory ascites. The development of ascites or refractory ascites was not as sociated with any alteration in systemic haemodynamics. Eur J Gastroenterol Hepatol 13:251-256 (C) 2001 Lippincott Williams & Wilkins.