geoscience.net logo
+ Resolve Article
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter

+ Translate
+ Subscribe to Site Feed
GeoScience Most Shared ContentMost Shared Content

Prevention of hepatorenal syndrome in patients with cirrhosis and ascites: a pilot randomized control trial between pentoxifylline and placebo


, : Prevention of hepatorenal syndrome in patients with cirrhosis and ascites: a pilot randomized control trial between pentoxifylline and placebo. European Journal of Gastroenterology & Hepatology 23(3): 210-217

Pentoxifylline is effective in prevention of hepatorenal syndrome (HRS) in alcoholic hepatitis. The aim of this study was to assess the efficacy of pentoxifylline for prophylaxis of HRS in patients with cirrhosis and ascites. One hundred and seventy-six consecutive patients with cirrhosis and ascites were screened. Patients with creatinine clearance (Ccl) between 41 and 80 ml/min and serum creatinine of less than 1.5 mg/dl in absence of renal disease were randomized to receive either pentoxifylline (group A, 1200 mg/day) or placebo (group B) for 6 months. Patients were followed monthly for 6 months, and kidney function tests were carried out at baseline, 1, 3, and 6 months. Primary endpoint was the development of HRS within 6-month follow-up. Thirty-five patients each were randomized to group A and group B. Of the 70 patients, 61 completed follow-up (group A, n = 30 and group B, n = 31). In group A, serum creatinine remained stable at 1 month (0.94±0.2 vs. 0.90±0.4 mg/dl, P = 0.43), at 3 months (0.94±0.2 vs. 0.80±0.3 mg/dl, P = 0.10), and at 6 months (0.94±0.2 vs. 0.8±0.2 mg/dl, P = 0.06). Improvement occurred in Ccl at 1 month (61.7±16.0 vs. 82.0±30.0 ml/min, P = 0.001) and at 3 months (61.7±16.0 vs. 86.2±30.7 ml/min, P = 0.001). Serum sodium in group A showed progressive improvement at 1 month (134.7±4.4 vs. 137.0±5.3 mmol/l, P = 0.006), at 3 months (134.7±4.4 vs. 138.4±5.4 mmol/l, P = 0.004), and at 6 months (134.7±4.4 vs. 137.6±4.9 mmol/l, P = 0.009). Similarly, mean arterial pressure (MAP) also showed progressive improvement at 1 month (76.7±6.7 vs. 81.8±6.9 mmHg, P = 0.001), at 3 months (76.7±6.7 vs.82.3±6.2 mmHg, P = 0.001), and at 6 months (76.7±6.7 vs. 82.6±6.1 mmHg, P = 0.01). Tumor necrosis factor (TNF) level measured at baseline and at 3 months (14.4±4.8 vs. 13.1±3.7 pg/ml, P = 0.28) showed no difference in group A patients. In group B, serum creatinine increased gradually at 1 month (0.80±0.2 vs. 1.0±0.2 mg/dl, P = 0.007), at 3 months (0.80±0.2 vs. 1.1±0.3 mg/dl, P = 0.001), and at 6 months (0.80±0.2 vs.1.1±0.2 mg/dl, P = 0.001). Ccl at 1 month (63.1±14.5 vs. 66.8±28.2 ml/min, P = 0.37) decreased at 3 months (63.1±14.5 vs. 54.4±18.3 ml/min, P = 0.008). Serum sodium, in group B, showed progressive decline at 1 month (136.2±5.0 vs. 132.7±3.2 mmol/l, P = 0.02) and at 6 months (136.2±5.0 vs. 132.7±3.4 mmol/l, P = 0.002). MAP remained stable at 1 month (75.1±7.5 vs. 75.3.8±5.1 mmHg, P = 0.86), at 3 months (75.1±7.5 vs. 73.2±4.6 mmHg, P = 0.19), and at 6 months (75.1±7.5 vs. 74.1±6.1 mmHg, P = 0.06). TNF level also did not show any change at baseline and at 3 months (14.5±6.8 vs. 13.4±5.1 pg/ml, P = 0.31). Of the 12 patients who developed HRS, 10 patients were in group B (type 1 HRS, n = 9 and type 2 HRS, n = 1) and two patients (type-1 HRS, n = 2) were in group A (P = 0.01). Patients with HRS had higher baseline TNF-α (15.3±5.8 vs. 10.9±4.8 pg/ml, P = 0.01), lower MAP (68.0±3.8 vs. 77.8±6.5 mmHg, P = 0.01), and sodium level (131.2±3.0 vs. 135.6±4.7 mmol/l, P = 0.003) than those who did not develop HRS. Pentoxifylline is effective in preventing HRS in patients with cirrhosis and ascites at risk of HRS.

US$19.90

PMID: 21285885

DOI: 10.1097/MEG.0b013e3283435d76


Other references

Jenkins, J., 1979: The structure of the surface of the trophont of Hyalophysa chattoni. Proceedings of the International Congress of Protozoology, 5: 335

Tornetta, P.; Tiburzi, D., 1994: Anterograde interlocked nailing of distal femoral fractures after gunshot wounds. Standard treatment for distal femoral fractures has been with blade plate or condylar screw plate devices. Excellent fixation is obtained, but bone grafting is required and the procedure exposes the fracture site. More recently, indirect methods o...

Paige, G.D., 1991: Linear vestibulo-ocular reflex (LVOR) and modulation by vergence. Acta Oto-Laryngologica. Supplementum 481: 282-286

Anonymous, 2011: Correlates of 29 H1N1 influenza vaccine acceptability among parents and their adolescent children. School-aged children were a priority group for receipt of the pandemic (29) H1N1 influenza vaccine. Both parental and adolescent attitudes likely influence vaccination behaviors. Data were collected from surveys distributed to middle- and high-sch...

Gibb, A.C.; Dickson, K.A., 1998: Does metamorphosis affect the escape response of the California halibut, Paralichthys californicus?. American Zoologist 38(5): 84A

Hirsh, B.; Brothman, A.R.; Jacky, P.B.; Rao, K.W.; Wolff, D.J., 2005: Section E6 of the ACMG technical standards and guidelines: chromosome studies for acquired abnormalities. These standards and guidelines are designed primarily as an educational resourcefor clinical laboratory geneticists to help them provide quality clinical laboratory genetic services. Adherence to these standards and guidelines does not necessarily...

Larcombe, AN., 2003: Competition between a rainbow lorikeet and a twenty-eight parrot for a nesting hollow. Western Australian Naturalist. June 30; 241: 88

Lush, R.H., 1930: Pasture investigations in Louisiana. A review of recent investigations on pasture improvement with methods of expressing pasture value is presented. The percentage difference in total digestible nutrients required and that in feed fed is credited to pasture. According to this method,...

Moisseiev, J.; Bartov, E.; Treister, G.; Blumenthal, M., 1982: Ocular laser hazards. Harefuah 102(2): 73-76

Hashimoto K.; Murakami K.; Ohno N.; Kageyama J.; Aoki Y.; Takahara J.; Ota Z., 1983: A specific radio immunoassay for corticotropin releasing factor using synthetic ovine corticotropin releasing factor. This newly developed specific radioimmunoassay for corticotropin releasing factor (CRF) had a sensitivity range of 25 pg/tube-4 ng/tube. Intra- and interassay coefficent of variation were 4.6% and 9.8%, respectively. Rat median eminence extracts s...