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Tens Asitli Dekompanse Sirotik Hastalarda Terlipressin İle Birlikte Albumin Uygulamasının 24 Saatlik İdrar Volümü ve Üriner Sodyum Atılımına Etkisi

Effect Of Terlipressin Plus Albumin Administration On 24 Hours Urine Volume And Urinary Sodium Excretion In Decompensated Cirrhotic Patients With Tense Ascites

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Abstract (2. Language): 
Large volume paracentesis is a commonly used treatment method in decompensated cirrhotic patients with tence ascites. However, hypovolemia and arterial vasodilatation that may be caused by paracentesis lead to some negative consequences, such as renal functional impairements, hyponatremia and hepatorenal syndrome all of which are called as “paracentesis-related circulatory dysfunction”. In this study, comparison of efficacy of Terlipressin plus Albumin versus Albumin alone on 24 hours urine volume and urinary sodium excretion during therapeutic paracentesis in decompensated cirrhotic patients with tence ascites was made. Statistically significant increases in 24 hour-urine volume and sodium excretion were found at the end of the treatment compared to the pretreatment levels in each group. [In the Terlipressin plus Albumin group, pre and pos-treatment urine volume 1103±220 mL/24 h, 1269±474 mL/24 h, respectively (p=0.03), pre and post-treatment urinary sodium excretion 26.0±9.1 mEq/24 h, 40.7±31.0 mEq/24 h, respectively (p=0.03). In the Albumin group, pre and pos-treatment urine volume 1229±351 mL/24 h, 1561±459 mL/24 h, respectively (p=0.003), pre and pos-treatment urinary sodium excretion 48.7±37.3 meq/24 h, 102.3±86.1 meq/24 h, respectively (p=0.008)]. A statistically significant decrease in serum creatinin level was observed in the combination group, but not in the Albumin group. As a result, the administration of Terlipressin plus Albumin during paracentesis was found to be able to effective in selected patients. However, it was concluded that this application can not routinely be suggested because of the fact that Terlipressin has systemic adverse effects and an expensive treatment modality, that limit its clinical use.
Abstract (Original Language): 
Tens asitli dekompanse sirotik hastalarda geniş volümlü parasentez sıklıkla kullanılan bir tedavi yöntemidir. Ancak parasenteze bağlı gelişebilen hipovolemi ve arteriyel vazodilatasyon; renal fonksiyonlarda bozulma, hiponatremi ve hepatorenal sendrom gibi “parasenteze bağlı dolaşım bozukluğu” adı verilen bir takım olumsuz sonuçlara yol açmaktadır. Bu çalışmada dekompanse sirotik hastalarda, terapötik parasentez esnasında Terlipressin ve Albumin’in birlikte kullanılması ile Albumin’in tek başına kullanılmasının 24 saatlik idrar volümü ve üriner sodyum atılımındaki etkinlikleri karşılaştırıldı. Tedavi sonunda hem kombinasyon grubunda hemde tekli Albumin grubunda tedavi öncesine göre 24 saatlik idrar volümünde ve sodyum atılımında istatistiksel olarak anlamlı düzeyde artış tespit edildi. [Terlipressiin + Albumin grubunda; tedavi öncesi ve sonrası idrar volümü 1103±220 mL/24 saat, 1269±474 mL/24 saat (p=0.03), tedavi öncesi ve sonrası üriner sodyum atılımı 26.0±9.1 meq/24 saat, 40.7±31.0 meq/24 saat (p=0.03). Albumin grubunda tedavi öncesi ve sonrası idrar volümü 1229±351 mL/24 saat, 1561±459 mL/24 saat (p=0.003), tedavi öncesi ve sonrası üriner sodyum atılımı 48.7±37.3 meq/24 saat, 102.3±86.1 meq/24 saat (p=0.008)]. Kombinasyon grubunda tekli Albumin grubundan farklı olarak sadece serum kreatinin düzeylerinde istatistiksel anlamlılığa ulaşan bir düşüş olduğu görüldü. Sonuç olarak seçilmiş vakalarda parasentez esnasında Terlipressin ile birlikte Albümin uygulamasının faydalı olabileceği tespit edildi. Ancak, Terlipressin’in klinik kullanımını sınırlandıran sistemik yan etkileri ve yüksek maliyetli bir tedavi olması nedeni ile bu uygulamanın rutin olarak önerilemeyeceği kanaatine varıldı.

REFERENCES

References: 

1. Vila MC, Sola R, Molina L, et al. Hemodynamic changes in
patients devoloping effective hypovolemia after total
paracentesis. J Hepatol 1998;28(4):639-645.
2. Gentile S, Angelico M, Bologna E, et al. Clinical, biochemical
and hormonal changes after a single, large volume
paracentesis in cirrhosis with ascites. Am J Gastroenterol
1989;84(3):279-284. C. Çekiç, ark.
28
3. Ruiz-del-Arbol R, Monescillo A, Jimenez W, et al.
Paracentesis-induced circulatory disfunction: mechanism and
effect on hepatic hemodynamics in cirrhosis. Gastroenterology
1997;113:579-586.
4. Gines A, Fernandez EG, Monescillo A, et al. Randomized trial
comparing albumin, dextran 70 and polygeline in cirrhotic
patients with tense ascites by paracentesis. Gastroenterology
1996;111:1002-1010.
5. Altman C, Bernard B, Roulet D, et al. Randomized
comparative multicenter study of hydroxiethyl starch versus
albumin as a plasma expander in cirrhotic patients with tense
ascites treated with paracentesis. Eur J Gastroenterol Hepatol
1998;10:5-10.
6. Moreau R, Asselah T, Condat B, et al. Comparison of the
effect of terlipressin and albumin on arterial blood volume in
patients with cirrhosis and tense ascites treated by paracentesis
a randomized pilot study. Gut 2002;50:90-94.
7. Moreau R, Soubrane O, Hadengue A, et al. Hemodynamic
effects of the administration of terlipressin alone or combined
with nitroglycerin in patients with cirrhosis. Gastroenterol
Clin Biol 1992;16:680-686.
8. Moller S, Hansen EF, Becker U, et al. Central and systemic
hemodynamic effects of terlipressin in portal hypertensive
patients. Liver 2000;20:51-59.
9. Nilsson G, Lindblom P, Ohlin M, et al. Pharmacokinetics of
terlipressin after single intravenous doses to healthy
volunteers. Drugs Exptl Clin. Res 1990;6:307-314.
10. Uriz J, Gines P, Cardenas A, et al. Terlipressin plus albumin
infusion: an effective and safe therapy of hepatorenal
syndrome. J Hepatol 2000;33:43-48.
11. Freeman JG, Barton JR, Record CO. Hemodynamic responses
to 1.25 and 2 mg of terlipressin intravenously in man. Aliment
Pharmacol Ther 1988;2(4):361-367.
12. 12Feu F, R. Del AR, Banares R, et al. Double-blind
randomized controlled trial comparing terlipressin and
somatostatin for acute variceal hemorrhage. Variceal bleeding
study group. Gastroenterology 1996;111(5):1291-1299.
13. Walker S, Kreichgauer HP, Bode JC. Terlipressin versus
somatostatin in the treatment of bleeding esophageal varices.
Final report of a placebo-controlled, double-blind study. Z
Gastroenterol 1996;34(10):692-698.
14. Mulkay JP, Louis H, Donckier V, et al. Long-term terlipressin
administration improves renal function in cirrhotic patients
with type 1 hepatorenal syndrome: a pilot study. Acta
Gastroenterol Belg 2001;64(1):15-19.
15. Moreau R, Durand F, Poynard T, et al. Terlipressin in patients
with cirrhosis and type 1 hepatorenal syndrome: A
retrospective multicenter study. Gastroenterolgy
2002;122:923-930.
16. Moore KP, Wong F, Gines P, et al.The management of ascites
in cirrhosis: Report on the Consensus Conference of the
International Ascites Club. J Hepalol 2003;38:258-266.
17. Elizalde I, Zozaya J. Treatment of ascites in cirrhotic patients.
An Sist Sanit Navar 2001;24(3):327-337.
18. Sola Vera J, Minana J, Ricart E, et al. Randomized trial
comparing albumin and saline in the prevention of
paracentesis induced circulatory dysfunction in cirrhotic
patients with ascites. Hepatology 2003;37:1147-1153.
19. Rosario R, Lalanne B, Lebre P, et al. Myocardial infarction
after injection of terlipressin for digestive hemorrhage.
Gastroenterol Clin Biol 1996;20(8-9):712-713.
20. Douriez E, Mollard P, Laval C, et al. Severe hyponatremia
after repeated administration of terlipressin. Therapie
1993;48(5):518-519.

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