RANDOMIZED COMPARATIVE-STUDY OF EFFICACY OF FUROSEMIDE VERSUS SPIRONOLACTONE IN NONAZOTEMIC CIRRHOSIS WITH ASCITES - RELATIONSHIP BETWEEN THE DIURETIC RESPONSE AND THE ACTIVITY OF THE RENIN-ALDOSTERONE SYSTEM

  • 1 January 1983
    • journal article
    • research article
    • Vol. 84  (5) , 961-968
Abstract
Loop and distal diurectics are the basic drugs for the treatment of ascites. Although pharmacologic studies indicate that the natriuretic potency of loop diuretics is much greater than that of distal diuretics, there are no studies comparing the efficacy of these drugs in cirrhosis. Nonazotemic cirrhotic patients [40] with ascites and avid Na+ retention were randomly allocated into 2 groups. Group 1 contained 21 patients treated with furosemide; group 2 contained 19 ptients treated with spironolactone. The initial doses were 80 and 150 mg/day, respectively. These doses were increased to 160 and 300 mg/day, respectively, if there was no response. Cases not responding to furosemide and spironolactone were later treated with spironolactone and furosemide, respectively. In group, 11 of the 21 patients responded to furosemide; in group 2, 18 of the 19 patients responded to spironolactone (P < 0.01). Of the 10 patients in group 1 not responding to furosemide, 9 responded later to spironolactone. The diuretic response to furosemide and spironolactone was related to the activity of the renin-aldosterone system. Patients with higher renin and aldosterone did not respond to furosemide and required 300 mg/day of spironolactone to achieve a diuretic response. Evidently, at these dosages, spironolactone is more effective than furosemide in nonazotemic cirrhosis with ascites, and the activity of the renin-aldosterone system influences the diuretic response to furosemide and spironolactone in these patients.