Effects of a long-acting formulation of octreotide on renal function and renal sodium handling in cirrhotic patients with portal hypertension: A randomized, double-blind, controlled trial

Octreotide seems to have a beneficial effect on variceal bleeding, and long -term administration for the prevention of rebleeding is currently being ev aluated. Experimental studies have suggested a beneficial effect of chronic octreotide treatment on renal function, while clinical studies have shown variable effects. Twenty-five cirrhotic patients with portal hypertension w ere randomized in a double-blind design to placebo or a single subcutaneous dose of a long-acting formulation of octreotide (octreotide-LAR) (20 mg). Renal function tests were performed before dosing and repeated after 30 day s. The patients were in sodium steady state at the time of study. Glomerula r filtration rate (GFR) and effective renal plasma flow (ERPF) were measure d by a constant infusion clearance technique. Renal sodium handling was det ermined by lithium and sodium clearance measurements. Therapeutic serum lev els of octreotide along with a reduction of insulin-like growth factor I (I GF-I) (P < .01) and an increase of IGF binding protein 1 (P < .05) were dem onstrated. No effect of octreotide was observed on GFR, ERPF, or filtration fraction (GFR/ERPF). Changes in clearance and extraction fraction of sodiu m and lithium during octreotide treatment were not significantly different from those of placebo. In addition, no changes in free water clearance, uri nary flow rate, or 24-hour Na excretion were demonstrated. A significant in crease of mean arterial pressure (+5 mm Hg; P < .01) was observed after tre atment with octreotide-LAR. It is concluded that in spite of increased arte rial pressure, octreotide-LAR has no significant effect on renal hemodynami cs and tubular function in clinically stable cirrhotic patients with portal hypertension.