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Oral midodrine is comparable to albumin infusion in cirrhotic patients with refractory ascites undergoing large-volume paracentesis

results of a pilot study

Yosry, Aymana; Soliman, Zeinab A.a; Eletreby, Rashaa; Hamza, Imana; Ismail, Alaab; Elkady, Mohammad A.b

European Journal of Gastroenterology & Hepatology: March 2019 - Volume 31 - Issue 3 - p 345–351
doi: 10.1097/MEG.0000000000001277
Original Articles: Hepatology

Background and aims Albumin infusion reduces the incidence of postparacentesis circulatory dysfunction among patients with cirrhosis and tense ascites compared with no treatment. Less costly treatment alternatives such as vasoconstrictors have been investigated, but the results are controversial. Midodrine, an oral α1-adrenergic agonist, increases effective circulating blood volume and renal perfusion by increasing systemic and splanchnic blood pressure. Our aim is to assess whether or not morbidity in terms of renal dysfunction, hyponatremia, systemic, or portal hemodynamics derangement or mortality differed in patients receiving albumin versus midodrine.

Patients and methods Seventy-five patients with cirrhosis and refractory ascites were randomized to receive albumin infusion, oral midodrine for 2 days, or oral midodrine for 30 days after therapeutic large volume paracentesis (LVP). The primary endpoints were development of renal impairment or hyponatremia, change in systemic and portal hemodynamics, cost, and mortality in the short-term and long-term follow-up.

Results No significant difference was found between groups in the development of renal impairment, hyponatremia, or mortality 6 and 30 days after LVP. A significant increase in 24-h urine sodium excretion was noted in the midodrine 30-day group. Renal perfusion improved significantly with the midodrine intake for 30 days only. The cost of midodrine therapy was significantly lower than albumin.

Conclusion Midodrine is as effective as albumin in reducing morbidity and mortality among patients with refractory ascites undergoing LVP at a significantly lower cost. Long-duration midodrine intake can be more useful than shorter duration intake in terms of improvement of renal perfusion and sodium excretion.

aDepartment of Endemic Medicine and Hepatogastroenterology, Faculty of Medicine, Cairo University

bDepartment Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt

Correspondence to Zeinab A. Soliman, MD, Department of Endemic Medicine and Hepatogastroenterology, Cairo University, 11562 Cairo, Egypt Tel: +20 111 234 4415; e-mail:

Received March 26, 2018

Accepted June 20, 2018

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