Midodrine in patients with cirrhosis and refractory or recurrent ascites: A randomized pilot study

Singh, Virendra; Dhungana, Sahdeb P.; Singh, Baljinder; Vijayverghia, Rajesh; Nain, C. K.; Sharma, Navneet; Bhalla, Ashish; Gupta, Pramod Kumar

doi:10.1016/j.jhep.2011.04.027

Cited by 87 publications

(128 citation statements)

References 31 publications

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“…Administration of (midodrine) significantly improves systemic haemodynamics, renal function and sodium Excretion in non azotemic cirrhotic patients with tense ascites, Midodrine (an alpha adrenergic agonist) has been used to improve renal haemodynamics in cirrhotics with ascites. In these patients, it increases effective arterial blood volume by causing splanchnic vasoconstriction and improves renal perfusion and glomerular filtration [18].…”

Section: Discussionmentioning

confidence: 99%

Effect of Midodrine in Patients with Liver Cirrhosis and Refractory Ascites

Obiedallah¹

2017

AJIM

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Section: Discussionmentioning

confidence: 99%

Effect of Midodrine in Patients with Liver Cirrhosis and Refractory Ascites

Obiedallah¹

2017

AJIM

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“…Similarly, Krag and colleagues found that patients with a low cardiac index (< 1.5L/ min/m 2 ) significantly developed more hepatorenal syndrome and had decreased survival rate compared to those with a cardiac index above 1.5 L/min/m 2 [33] . Correspondingly, several studies confirmed this concept by showing that midodrine, an alpha-1 adrenergic agonist, was beneficial in patients with advanced cirrhosis [35][36][37][38][39] . Midodrine therapy increased urinary volume, urinary sodium excretion, blood pressure, and decreased plasma renin activity and overall mortality [39] .…”

Section: Blood Pressure and Cirrhosismentioning

confidence: 99%

“…Correspondingly, several studies confirmed this concept by showing that midodrine, an alpha-1 adrenergic agonist, was beneficial in patients with advanced cirrhosis [35][36][37][38][39] . Midodrine therapy increased urinary volume, urinary sodium excretion, blood pressure, and decreased plasma renin activity and overall mortality [39] . Also, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) reduced cardiac index and MAP resulting in worsened outcomes in patients with advanced cirrhosis and ascites [40][41][42][43] .…”

Section: Blood Pressure and Cirrhosismentioning

confidence: 99%

Non-Selective Beta-Blockers in Liver Cirrhosis: Friends or Foes? A Review of the Literature

Abboud

Tabet

2016

Journal of Gastroenterology and Hepatology Research

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in cirrhosis, and try to provide logical suggestions concerning the use of this class of medication in patients with cirrhosis. INTRODUCTIONCirrhosis is becoming a leading cause of mortality and morbidity worldwide [1,2] , and since 1981, beta-blockers were found to be highly efficacious in both, primary and secondary prevention of variceal bleeding [3] . Non-selective beta-blockers (NSBB) became the cornerstone of the medical treatment of patients with cirrhosis [3] , and this was demonstrated in several solid studies. However, recent evidence has questioned the use of beta-blockers in patients with end-stage liver disease and refractory ascites [3] . In this article, we are going to review almost all the previous studies about beta-blocker therapy in patients with cirrhosis, and find out the beneficial effects of this therapy, its potential complications and harms, and try to provide suggestions regarding its appropriate use in this specific category of patients. CIRRHOSISCirrhosis represents an advanced stage of progressive hepatic fibrosis characterized by distortion of the hepatic architecture and the formation of regenerative nodules. It is normally considered to be irreversible in its late stages at which point the only therapeutic ABSTRACTCirrhosis has become a leading cause of death in the United States and worldwide owing the increased prevalence of alcoholic liver disease, hepatitis C, and more recently, non-alcoholic steatohepatitis and nonalcoholic fatty liver disease. Beta-blockers have been proven to be efficacious in primary, as long as secondary prophylaxis of variceal bleeding, more than 35 years ago. Nonetheless, recent data has cautioned the use of beta-blockers in patients with end-stage cirrhosis and refractory ascites suggesting increased mortality from betablockers in this group of patients. In this article, we will discuss this topic in details, and review the conflicting studies about beta-blockers REVIEW

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“…Terlipressin following intravenous human albumin increases urine volume and sodium excretion, and importantly enhances survival 10 but it is not effective in all cases. Midodrine improves renal parameters but it has not been convincingly shown to enhance survival 11 and so its role is not established. Renal replacement therapy has also not been shown to improve long-term survival but it has a role in the management of patients with severe acidosis, hyperkalaemia or severe volume overload.…”

Section: Hepatorenal Syndromementioning

confidence: 99%

Management of patients with decompensated cirrhosis

Harrison

2015

Clinical Medicine

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During the assessment of a patient with liver disease, fi nding the patient has decompensated cirrhosis, as defi ned by the presence of jaundice, ascites, variceal haemorrhage or hepatic encephalopathy, has major implications regarding management and prevention of cirrhosis-related complications, as well as consideration for a referral for liver transplantation evaluation. Prognosis is markedly worse in patients with decompensated compared with compensated cirrhosis. In general, any patient with decompensated cirrhosis should receive evaluation and medical care by a hepatologist. Since patients frequently present with more than one facet of liver decompensation, such cases pose a complex management challenge requiring input from a multidisciplinary team and close liaison with a liver transplant centre.

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Midodrine in patients with cirrhosis and refractory or recurrent ascites: A randomized pilot study

Cited by 87 publications

References 31 publications

Effect of Midodrine in Patients with Liver Cirrhosis and Refractory Ascites

Effect of Midodrine in Patients with Liver Cirrhosis and Refractory Ascites

Non-Selective Beta-Blockers in Liver Cirrhosis: Friends or Foes? A Review of the Literature

Management of patients with decompensated cirrhosis

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