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P38 Homodynamic effects of prolonged treatment with midodrine in non-azotemic pre-ascitic, ascitic and refractory ascites cirrhotic patients

Introduction Splanchnic arterial vasodilatation has related to hyperdynamic circulation and impaired natriuresis in advanced cirrhosis and was suggested to be responsible for the subtle sodium retention in pre-ascitic cirrhosis. α Adrenergic agonist may reverse this condition. Aim This study aimed to evaluate the effects of treatment with the α1-adrenergic agonist midodrine on systemic haemodynamics in non-azotemic cirrhotic patients. Method 154 cirrhotic patients were studied. The patients were classified into: absent ascites, mild to moderate diuretic responsive ascites and refractory ascites. Patients were randomly selected to receive either oral midodrine 10 mg, three times a day or placebo The following parameters were assessed for all patients: mean arterial pressure (MAP), cardiac output (CO), plasma rennin (Pl R) and renal resistive index (RRI) at baseline, 7 days after administration of oral midodrine 10 mg, three times daily, and 3 months after administration of oral midodrine 2.5 mg, three times a day. Results Midodrine administration induced a significant increase in MAP mention levels and P and significant decreases in CO mention levels and P in patients without and with mild to moderate ascites but not in patients with refractory ascites. As well as significant decreases in Pl R activity mention levels and P and RRI in patients without and with mild to moderate ascites but not in patients with refractory ascites Conclusion The administration of midodrine improves systemic haemodynamics associated with a suppression of the renin activity in cirrhotic patients without or with mild ascites. But had no effect in patients with refractory ascites