Biological factors influencing response to diuretics in patients with cirrhosis and ascites

Purposes - To examine the biological factors influencing response to diuretics in patients with cirrhosis and ascites. Methods - Sixty-nine patients were evaluated. Patients were classified into 3 groups : group 1 : "good responders" (responding to spironolactone 200 mg/day) group 2 : "bad responders" (responding to spironolactone do; e; above 200 mg/day or requiring of furosemide), and group 3 : "non-responders" (not responding to spironolactone 400 mg/day and furosemide 160 mg/day). Results - There were 30 patients in group 1, 24 in group 2 and 15 in group 3. The degree of activation of the renin-aldosterone and sympathetic system in group 2 was significantly higher than in group I and lower than in group 3. Natriuresis in group 2 (11 +/- 0.7 mEq/24h) was significantly below group 1 (20 +/- 2 mEq/24h) and above group 3 (5 +/- 0.6 mEq/24h). Conclusions - In patients with cirrhosis and ascites, the degree of requiring activation of the renin-aldosterone and sympathetic nervous system influences diuretic response of ascites and is estimated by measured baseline natriuresis.