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Combined versus sequential diuretic treatment of ascites in nonazotemic patients with cirrhosis: results of an open randomized clinical trial
  1. Paolo Angeli (pangeli{at}unipd.it)
  1. Department of Clinical and Experimental Medicine, University of Padova, Italy
    1. Silvano Fasolato (silvano.fasolato{at}unipd.it)
    1. Department of Clinical and Experimental Medicine, University of Padova, Italy
      1. Elena Mazza (elena329{at}interfree.it)
      1. Department of Clinical and Experimental Medicine, University of Padova, Italy
        1. Lios Okolicsanyi (lios.okolicsanyi{at}unipd.it)
        1. Division of Gastroenterology, General Hospital of Treviso, Italy
          1. Giulio Maresio (giuliomarv{at}gmail.com)
          1. Department of Clinical and Experimental Medicine, University of Padova, Italy
            1. Emanuela Velo (pierobone{at}libero.it)
            1. Division of General Medicine, General Hospital of Cittadella (Padova), Italy
              1. Alessandra Galioto (alegalioto{at}libero.it)
              1. Department of Clinical and Experimental Medicine, University of Padova, Italy
                1. Freddy Salinas (toropoy{at}libero.it)
                1. Division of General Medicine, Private Hospital, Italy
                  1. Maurizio D'Aquino (mdq{at}libero.it)
                  1. Division of General Medicine, Private Hospital, Italy
                    1. Antonietta Sticca (antonietta.sticca{at}unipd.it)
                    1. Department of Clinical and Experimental Medicine, University of Padova, Italy
                      1. Angelo Gatta (angelo.gatta{at}unipd.it)
                      1. Department of Clinical and Experimental Medicine, University of Padova, Italy

                        Abstract

                        Objective: The aim of the study was to compare sequential versus combined diuretic therapy in patients with cirrhosis, moderate ascites and without renal failure.

                        Design: One hundred patients were randomly assigned to the two diuretic treatments. The sequential one provided potassium canrenoate at the initial dose of 200 mg/day, then increased up to 400 mg/day. Non responders were treated with 400 mg/day of potassium canrenoate and furosemide at an initial dose of 50 mg/day, then increased up to 150 mg/day. The combined treatment provided the initial dose of 200 mg/day of potassium canrenoate and 50 mg/day of furosemide, then increased up to 400 mg/day and 150 mg/day, respectively.

                        Results: Most patients who received sequential treatment responded to potassium canrenoate alone (19 % to 200 mg/day and 52.63 % to 400 mg/day, respectively). Most patients who received the combined treatment responded to the first two steps (40% to the first one and 50% to the second one i.e. 400 mg/day of potassium canrenoate plus 100 mg/day of furosemide) Adverse effects (38% vs 20%, p < 0.05), in particular hyperkalemia (18% vs 4%, p < 0.05), were more frequent in patients who received sequential therapy. As a consequence, the percent of patients who resolved ascites without changing the effective diuretic step was higher in those who received the combined treatment (56 % vs 76%, p < 0.05).

                        Conclusions: The combined diuretic treatment is preferable to the sequential one in the treatment of moderate ascites in patients with cirrhosis and without renal failure.

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