The role of octreotide on renal function in patients with advanced cirrhosis

Advanced cirrhosis is characterized by arterial vasodilatation and the reduced arterial response to vasoconstrictors. Both of these are related to an increase of endothelial (prostacyclin and nitric oxide) and nonendothelial vasodilatators (glucagon) level. Experimental study had shown that the responsiveness to vasoconstrictors of the mesentery artery may be normalized by the inhibition of glucagon or nitric oxide. The aim of our study was to assess the effects on renal hemodynamics by the administration of octreotide, the synthetic somatostatin analog, an inhibitor of the release of endogenous vasodilatators.

We studied forty-six patients admitted at the University Hospital in Bucharest for advanced cirrhosis between 2000-2002. The patients aged (35-62) were divided in two groups: Group I--23 patients received intravenous octreotide by infusion of 50 microg/hour for three days; Group II--23 patients received placebo. Exclusion criteria were: A recent gastrointestinal bleeding; Hepatic encephalopathy; Serum creatinine > 1.5 mg/dl; Ultrasonographic evidence of renal disease or urinary tract obstruction.

Discontinuation of pharmacological treatment with beta-blockers, nitrates and angiotensin converting enzyme inhibitors 7 days before the study; Sodium restricted diet (35 mEq/day) 2 weeks before and during the study. All the patients underwent on day 0 and 3 the following; Routine laboratory tests, Creatinine clearance for glomerular filtration rate (GRF); Urinary sodium excretion (24 hours), Water diuresis, Lithium clearance, Plasma renin activity, Plasma aldosterone concentration, Medium blood pressure, Cardiac output (by ecocardiography).

Octreotide in a short infusion treatment induces an inhibitory effect on renin aldosterone secretion which may be responsible for the benefical effects on sodium excretion. The significant increase of MAP may be the result of an inhibition of vasodilatatory substances or an increased arterial responsiveness to vasoconstrictors. The significant effect on renal function in patients with advanced cirrhosis can be a promising therapeutic perspective in the treatment of hepatorenal syndrome.