Midodrine Superior to Octreotide in Improving the Hemodynamic Status of Cirrhosis Patients with Ascites

Table of Content

Background

Peripheral vasodilatation may decrease renal blood flow and subsequently increase the plasma renin activity (PRA) in cirrhosis patients. Octreotide with its multiple mechanisms results in peripheral arterial vasoconstriction. Midodrine, an alpha agonist acts as a peripheral vasoconstrictor. It is not known if midodrine would reduce PRA and improve renal function in cirrhosis patients with ascites.

Aim

To compare the ability of midodrine vs. octreotide to reduce PRA and increase estimated glomerular filtration rate (GFR) in cirrhotic patients

Patient Profile

Inclusion Criteria

  • Cirrhosis patients (group C as per the ChildPugh scoring system) with ascites (age 15-75 years; n=34)

Exclusion Criteria

  • Patient with gastrointestinal (GI) bleeding 7 days before enrollment and/or unstable hemodynamics
  • Patients with hepatic encephalopathy
  • Patients with infection (sepsis, spontaneous bacterial peritonitis) 30 days before the enrollment
  • Patients with diabetes or cardiovascular disease and hypertension
  • Patients with proven hepatocellular carcinoma or hepatorenal syndrome
  • Patients with known allergy to drugs

Methods

Study Design

  • A prospective randomized clinical trial

Treatment Strategy

  • Patients were randomized 1:1 as follows:

  • The dosage of diuretics (furosemide or spironolactone) was not altered two-to four days before treatment initiation
  • No diuretics were added or removed from the treatment regimen four days before initiating treatment or during treatment

Assessments

  • Serum creatinine, PRA, fasting body weight, blood pressure and eGFR were assessed before the treatment and on fourth day of the treatment

Outcomes

  • Changes in PRA
  • Changes in eGFR

Results

  • The etiology of cirrhosis or the cause for hospitalization did not differ much in the study groups.
  • Plasma rennin activity decreased significantly after treatment in both groups (p=0.008), with a greater decrease in the midodrine group (p=0.001) (Figure1).
Figure 1: Decrease in PRA in the study groups

  • Although eGFR increased significantly in both the groups (p=0.03), the increase was greater in the patients treated with midodrine vs. octreotide (p=0.01) (Figure 2).
Figure 2: Increase in eGFR in the study groups

  • The changes in blood pressure and body weight were similar in both the study groups.

Conclusions

  • Orally administered midodrine rather than subcutaneous octreotide was associated with greater suppression of PRA activity and a greater increase in eGFR in cirrhosis patients with ascites.
  • Midodrine thus has a more favorable impact on the hemodynamics vs. octreotide in nonazotemic cirrhosis patients with ascites

J Res Med Sci. 2011; 16 (1): 87–93.