Midodrine and Weekly Albumin Therapy in Patients With Cirrhosis and Diuretic Intractable or Recurrent Ascites: A...

Background Overwhelming splanchnic and systemic vasodilatation and low mean arterial pressure (MAP) pose significant challenges in mobilizing ascites in patients with decompensated cirrhosis. We aimed to evaluate the efficacy and survival benefits of oral vasoconstrictor and weekly albumin therapy in patients with diuretic intractable and recurrent ascites in cirrhosis. Materials and methods A total of 113 cirrhotic patients with diuretic intractable (n=45) and recurrent ascites (n=68) with MAP ≤ 82 mmHg were included. Of the 113 patients, 85 patients received midodrine (12.5±2.5 mg thrice daily) and weekly albumin 20-40 g/day to achieve a serum albumin level of 4 g/dL with standard medical therapy (SMT), whereas 28 patients received SMT alone. On follow-up, at three months, we evaluated and compared the control of ascites, urinary sodium, systemic vascular resistance (SVR), and renal arterial resistive index (RARI) between arm 1 and arm 2. Results Among 113 patients, mean Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease-sodium (MELD-Na) scores were comparable in both arms (CTP 9.52±1.16 and 9±1.18 and MELD 21.33±4.17 and 22.36±4.2 in arm 1 and arm 2, respectively). After three months of therapy in arm 1, a significant increase was seen in urinary sodium excretion (25.99±15.73 and 114.38±71.33 meq/24 hours), MAP (78.91±3.11 and 84.3±3.13 mmHg), SVR (1,059.4±23.09 and 1,178.3±12.39 dynes/s/cm⁵), and decrease in RARI (0.71±0.054 and 0.67±0.039) (p <0.05). The median overall survival and ascites control were better in arm 1 (p <0.001) at the end of follow-up (12 months). Conclusion Response-guided midodrine and weekly albumin therapy, along with SMT, have better overall survival and ascites control.