11. Rationalising diuretic use in Indian patients with decompensated liver cirrhosis: a stepping stone to set guidelines for Indian patients

Abstract

Background and Aims: To determine the dose requirement of commonly used diuretics among Indian patients with decompensated liver cirrhosis presenting with ascites. Methods: This prospective study was done at Gleneagles Global Health City, Chennai. Consecutive patients with cirrhosis and ascites attending outpatient clinic for from January to March 2018 were included. Patient information included age, gender, etiology of cirrhosis, state of origin, CTP score, MELD score, drug details, complications, need for paracentesis, and response to diuretic use at a single point. The primary outcome of the study was the need for a paracentesis. Indications for paracentesis were non-response to diuretics or inability to increase the dose due to complications. Chi square test and risk ratio calculation were done. p value <0.05 was considered statistically significant. Results: A total of 73 cases with median age of 54.6 years (range 26–74 years) and predominant male sex (61,83.6%) formed the study cohort. NASH and alcohol were the most common cause for liver cirrhosis. 68.5% of cases had MELD score >15 and 57% belonged to CTP class B. Majority of the cases (54, 74%) were on a combination of drugs with furosemide and spironolactone (20/50 mg) being the commonest dose. Nineteen patients were on a single drug with spironolactone being the most commonly prescribed drug (12,63%). Side effects of diuretics were noted in 48% of cases: renal dysfunction and dyselectrolytemia being the commonest. 25 patients required paracentesis. Diuretic induced complications and poor urine output were significantly more common among those requiring paracentesis. Conclusions: Indian patients seldom require high doses of diuretics and 48% develop complications related to diuretic use even at lower doses. The occurence of diuretic induced complications and poor urine output may be used as marker of requirement of paracentesis in Indian patients. The authors have none to declare.