Refractory ascites-the contemporary view on pathogenesis and therapy.

Beata Kasztelan-Szczerbinska,Halina Cichoz-Lach

doi:10.7717/peerj.7855

Abstract

Refractory ascites (RA) refers to ascites that cannot be mobilized or that has an early recurrence that cannot be prevented by medical therapy. Every year, 5–10% of patients with liver cirrhosis and with an accumulation of fluid in the peritoneal cavity develop RA while undergoing standard treatment (low sodium diet and diuretic dose up to 400 mg/day of spironolactone and 160 mg/day of furosemide). Liver cirrhosis accounts for marked alterations in the splanchnic and systemic hemodynamics, causing hypovolemia and arterial hypotension. The consequent activation of renin-angiotensin and sympathetic systems and increased renal sodium re-absorption occurs during the course of the disease. Cirrhotic patients with RA have poor prognoses and are at risk of developing serious complications. Different treatment options are available, but only liver transplantation may improve the survival of such patients.

Highlights

Liver cirrhosis and its complications are significant problems in Poland, as well as in populations of Western Europe and North America
Ascites refractory to treatment is one of the most serious complications caused by decompensated liver cirrhosis
When an insufficient natriuretic effect is observed, or more often, complications from treatment, the withdrawal of diuretics is recommended

Summary

INTRODUCTION

Liver cirrhosis and its complications are significant problems in Poland, as well as in populations of Western Europe and North America. According to National Vital Statistics Reports published in 2018, liver cirrhosis ranks 12th among the most common causes of death in the USA (Heron, 2018). The accumulation of ascitic fluid in the peritoneal cavity, a sign of decompensation, occurs in about 60% of patients within 10 years of the disease course. Ascites refractory to treatment is one of the most serious complications caused by decompensated liver cirrhosis. Resistance to conventional therapy develops in 5–10% of patients with cirrhotic ascites within a year of treatment (Siqueira, Kelly & Saab, 2009; Salerno et al, 2010).

SURVEY METHODOLOGY

Findings

CONCLUSIONS