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Long-term rifaximin therapy as a primary prevention of hepatorenal syndrome

Ibrahim, El-Sayeda; Alsebaey, Aymana; Zaghla, Hassana; Moawad Abdelmageed, Sabryb; Gameel, Khalida; Abdelsameea, Emana

European Journal of Gastroenterology & Hepatology: November 2017 - Volume 29 - Issue 11 - p 1247–1250
doi: 10.1097/MEG.0000000000000967
Original Articles: Liver Failure

Background Hepatorenal syndrome (HRS) is a severe complication of liver cirrhosis, with poor survival. Rifaximin is a gut-selective broad-spectrum antibiotic.

Aim The aim of this study was to evaluate the role of rifaximin as a primary prevention of HRS.

Patients and methods Eighty patients with liver cirrhosis and ascites were enrolled. They were randomized into two groups: control (n=40) and rifaximin group (n=40). Baseline liver function tests, renal function tests, complete blood count, international normalized ratio, urine analysis, and abdominal ultrasonography were carried out. Rifaximin 550 mg was administered twice daily for 12 weeks. Renal functions were measured every 4 weeks with monitoring of HRS occurrence and possible precipitating factor.

Results Both groups were matched for age, sex, virology, serum bilirubin, serum albumin, aspartate aminotransferase, alanine aminotransferase, hemoglobin, white blood cells, platelets, international normalized ratio, potassium, and Child–Pugh score. In contrast to the rifaximin group, the control group showed statistically significant serial blood urea nitrogen (18.84±7.17, 19.85±6.10, 21.54±4.79, and 22.96±5.82 mg/dl; P=0.001) and serum creatinine (0.94±0.25, 1.02±0.24, 1.12±0.16, and 1.21±0.17 mg/dl; P=0.001) levels. The overall blood urea nitrogen and serum creatinine change was statistically higher in the control group than the rifaximin group (20.8 vs. 18.24 mg/dl and 1.07 vs. 0.99 mg/dl, respectively). HRS developed more in the control group than the rifaximin group [9 (22.5%) vs. 2 (5%); P=0.048]. In both groups, HRS was precipitated by spontaneous bacterial peritonitis mainly and large volume paracentesis. The Child–Pugh score, control group, baseline serum sodium, and creatinine were predictors of HRS.

Conclusion Rifaximin may be useful as a primary prevention of HRS.

Departments of aHepatology and Gastroenterology

bClinical Biochemistry, National Liver Institute, Menoufia University, Shebeen El-Kom, Menoufia Governorate, Egypt

Correspondence to Ayman Alsebaey, MD, Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebeen El-Kom 32511, Menoufia Governorate, Egypt Tel: +20 100 375 1248; fax: +20 482 234 586; e-mail:

Received May 31, 2017

Accepted June 24, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.