Aldosterone antagonists are the first-line diuretic therapy for moderate ascites in patients with cirrhosis. In patients who do not respond to aldosterone antagonists alone, the addition of a loop diuretic is recommended; however, for patients with recurrent ascites, receiving a combination of agents from the start might be preferable to such 'sequential' therapy.
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References
Angeli, P. et al. Combined versus sequential diuretic treatment of ascites in non-azotaemic patients with cirrhosis: results of an open randomised clinical trial. Gut 59, 98–104 (2010).
Ginès, P. et al. EASL practice guidelines on the management of ascites and spontaneous bacterial peritonitis. J. Hepatol. (in press).
Garcia-Tsao, G. & Lim, J. Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program. Am. J. Gastroenterol. 104, 1802–1829 (2009).
Runyon, B. A. & AASLD Practice Guidelines Committee. The management of adult patients with ascites due to cirrhosis: an update. Hepatology 49, 2087–2107 (2009).
Moore, K. P. & Aithal, G. P. Guidelines on the management of ascites in cirrhosis. Gut 55 (Suppl. 6), vi1–vi12 (2006).
Santos, J. et al. Spironolactone alone or in combination with furosemide in the treatment of moderate ascites in nonazometic cirrhosis. A randomized, comparative study of efficacy and safety. J. Hepatol. 39, 187–192 (2003).
Acknowledgements
P. Ginès has been supported by grants received from Ministerio de Ciencia e Innovación (FIS 2008080126 Instituto de Carlos III), (EC07/90077, Instituto de Carlos III). CIBEReHD is funded by the Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBEReHD. The author would also like to thank Nicki van Berckel for her administrative support.
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Ginès, P. Diuretic agents for ascites: joining forces from the start?. Nat Rev Gastroenterol Hepatol 7, 310–311 (2010). https://doi.org/10.1038/nrgastro.2010.63
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DOI: https://doi.org/10.1038/nrgastro.2010.63
