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.