Predictors of induction and sustainability of response to diuretic therapy in patients with decompensated chronic liver disease

Abstract EN

Background: Factors involved in individual’s response to loop diuretics in cirrhotic patients with ascites are many, which renders it difficult to austerely predict response to diuretic therapy in those patients.

The aim of this study was to evaluate factors which determine initial response to loop diuretic therapy in those patients and to determine whether such factors can predict a sustained diuresis response.

Patients and Methods: One hundred and ten patients with non-malignant chronic liver disease and ascites were treated with IV furosemide in doses according to serum creatinine together with oral spironolactone 50mg twice daily.

Before and during the diuretic therapy a set of clinical and laboratory variables were investigated as possible predictive factors influencing the therapeutic response to diuretics.

The renal arterial resistive index (RI) (reflecting renal vascular resistance) was estimated with duplex Doppler ultrasonography.

Results: Our study revealed statistically significant relation between high ascites grade(p=0.013), higher Child-Pugh class (p< 0.001), higher baseline serum creatinine & lower eGFR (p< 0.001), and high renal resistive index (p=0.002) with poor diuretic response.

Conclusion: combining both clinical and laboratory findings together with elevated baseline renal resistive index would be helpful in early identification of the subgroup of patients who are at higher risk of diuretic resistance.