The Significance of the Furosemide Test for Predicting Ascites Control by Diuretics in Cirrhotics: A Comparison with Volume Expansion and Octreotide Infusion

Abstract

To verify prospectively the usefulness of the furosemide-induced natriuresis test in predicting ascites control by medical treatment, 15 stable cirrhotics (9 male) with ascites were studied. Sodium excretion was measured after this test and after volume expansion with saline associated with intravenous infusion of octreotide; 6 months later, response to medical treatment was rated as good (N=9) or poor (N=6). Patients with poor ascites control had lower sodium excretion with the furosemide-induced natriuresis test (median, 88 vs 201 mmol; P < 0.01). Poor control was observed in four of four patients with sodium excretion < or =125 mmol, and good control in six of six patients with sodium excretion >175 mmol (P < 0.002). Volume expansion was followed by limited natriuresis (median, 20 mmol), in inverse relationship with plasma active renin concentration (P < 0.001). In conclusion, long-term ascites control is well predicted by the furosemide-induced natriuresis test.

Management of adult patients with ascites due to cirrhosis

“…Although an intravenous dose of 80 mg furosemide can cause an acute reduction in renal perfusion and subsequent azotemia in patients with cirrhosis and ascites, this same dose has been shown in one study to separate diuretic‐resistant (<50 mmol urine sodium in 8 hours) from diuretic‐sensitive patients (>50 mmol) 69. Another study has confirmed this observation 70. This intravenous furosemide “test” may help speed detection of diuretic‐resistant patients so that they can more rapidly be given second‐line treatment options 69.…”

“…Shunt placement has been shown in controlled trials to decrease the duration of hospitalization, decrease the number of hospitalizations, and decrease the dose of diuretics 63, 110. However, poor long‐term patency, excessive complications, and no survival advantage compared to medical therapy in controlled trials have led to near abandonment of this procedure 70, 110. A randomized controlled trial of uncoated TIPS versus peritoneovenous shunt reports better long‐term efficacy in the TIPS group 111.…”

Efficacy of combination therapy with natriuretic and aquaretic drugs in cirrhotic ascites patients: A randomized study

“…Addition of tolvaptan had only a slight influence on ammonia levels, and that the incidence of hepatic encephalopathy was reduced in the tolvaptan group, compared to furosemide. Hepatic encephalopathy is related to impaired blood circulation, which decreases renal clearance of ammonia[ 26 , 27 ]. In contrast to furosemide, tolvaptan increases urine output without decreasing renal blood flow, leading to indistinguishable ammonia levels in the tolvaptan group between the baseline and the final dosing day.…”