A clinical audit of diuretic use in a cohort of patients with decompensated chronic liver disease in South India

Abstract

Background and Aim: Diuretic doses for the optimal management of ascites may be influenced by the patient profile and conditions. We undertook this study to map the usage of common diuretics, alone or in combination, for the management of patients with decompensated cirrhosis and to determine the prevalence of adverse effects with the administered regimens and factors that predict the need for paracentesis while on diuretics. Methods: This prospective study was done in an outpatient clinic among patients with known liver cirrhosis, irrespective of etiology, belonging to Child-Pugh Class B or C, with mild to moderate ascites and no dyselectrolemia on diuretics. The primary outcome of the study was the need for paracentesis. The type and dose of diuretic at this instance were noted. Results: A total of 200 patients (168 male), predominantly from southern Indian states, formed the study group. The median model for endstage liver disease score was 18 and 70% of cases required paracentesis within 3 months. The single diuretic agent was used in 18% of cases while combination of two diuretics was used in 82%. Spironolactone was the most common single agent used (26, 72.2%). The combination of furosemide and spironolactone was the most common diuretic combination used (89.6%, 147 cases). One hundred and thirty patients (65%) reported the adverse effects to diuretics. Renal dysfunction and electrolyte disturbances were the most common adverse effects. Adverse effects to diuretic use and frequency of large volume paracentesis were significantly more common in patients taking furosemide 40 mg and spironolactone 100 mg per day. Conclusions: Indian patients with decompensated chronic liver disease do not appear to tolerate the high doses of diuretics and 65% of them develop diuretic-related adverse effects. There is a need to formulate the guidelines for the optimal management of ascites in decompensated chronic liver disease in the Indian setting.