Effect of a diet with unrestricted sodium on ascites in patients with hepatic cirrhosis

Xi-Bing Gu, Xiao-Juan Yang, Hong-Ying Zhu, Bo-Yu Xu, Xi-Bing Gu, Xiao-Juan Yang, Hong-Ying Zhu, Bo-Yu Xu

Abstract

Background/aims: There has been debate on whether a sodium-restricted diet (SRD) should be used in cirrhotic patients with ascites in China in recent years. The purpose of this study was to compare the effect of sodium-restricted and unrestricted diets on plasma renin activity (PRA), renal blood flow (RBF) and ascites in patients with liver cirrhosis.

Methods: Two hundred cirrhotic patients with ascites were randomly divided into two groups (98 cases in the sodium-unrestricted diet [SUD] group and 102 cases in the SRD group); 95 patients (96.94%) in the SUD group and 97 patients (95.1%) in the SRD group had post-hepatitis B cirrhosis.

Results: Blood sodium and RBF were higher in SUD group than in SRD group (p<0.001), while PRA were significantly lower in SUD group than the SRD group 10 days after treatment (p<0.001). Renal impairment caused by low blood sodium was higher in SRD group than in SUD group (p<0.01). Ascites disappeared in higher proportion of patients in SUD group than in SRD group (p<0.001).

Conclusions: SUD can increase the level of blood sodium and RBF, and be beneficial to diuresis and ascite reduction and disappearance.

Keywords: Albumin; Ascites; Liver cirrhosis; Renal circulation; Sodium-unrestricted diet.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Randomized controlled trial of effect of sodium-unrestricted diet (SUD) on ascites in patients with hepatic cirrhosis. Progressive flow at different stages. Our hospital have received 271 cases of cirrhosis ascites assessed for the eligibility from January 2007 to May 2010. Of all the cases, 71 patients are excluded, 61 cases not meeting the inclusion criteria and 10 cases refusing to participate. The left 200 patients were randomly divided into two groups, 98 cases of SUD and 102 cases of sodium-restricted diet (SRD). The patients in both SUD and SRD groups receive intervention. Spontaneous bacterial peritonitis occurred in 1 case of SUD group on the fifth day after treatment. Upper digestive tract bleeding occurred in 1 case of SRD group on the third day after treatment and the two cases withdrew from the trial. Ninety-seven cases in SUD group and 101 cases in SRD group accomplished the trial until discharge or death.

References

    1. Moore KP, Wong F, Gines P, et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology. 2003;38:258–266.
    1. Runyon BA Practice Guidelines Committee, American Association for the Study of Liver Diseases (AASLD) Management of adult patients with ascites due to cirrhosis. Hepatology. 2004;39:841–856.
    1. Zeng X, Lin Y, Xie WF. My view of sodium restriction in the treatment of cirrhotic ascites. Chin J Dig. 2007;27:331–333.
    1. Gu XB, Liu XY, Xu YQ, et al. Influence of diet with or without sodium restriction on renal flow and ascites subsidence of patients with cirrhosis. Chin J Dig. 2008;28:61–62.
    1. Gu XB, Chen HK, Zhu YF, Pei H, Liu XY. Influence of Na supplement and limitation on blood PRA, AII, ALD and renal function in patients with liver cirrhosis. Zhonghua Gan Zang Bing Za Zhi. 2004;12:370.
    1. Gu XB, Chen HK, Zhu YF, Pei H. Influence of sodium supplement and restriction on subsidence of cirrhotic ascites. Chin J Infect Dis. 2004;22:129–130.
    1. Liu JJ, Wu XY, Zhi H, Li N. Sodium restriction to correct cirrhotic ascites and application of hypertonic NaCl in ascites patients. Clin Focus. 2000;15:1141–1143.
    1. Wang XC, Sun Q, Yu GL, Gao PJ, Pu YF. Color Doppler study on hepatorenal syndrome and renal artery hemodynamics in non-compensation period of cirrhosis. J Clin Hepatobiliary Dis. 1996;12:212–213.
    1. Liang CX, Yu LD, Zhang Q, Chen XH, Guan YF. Color Doppler study on renal artery hemodynamics of normal adults. J Ultrasonic Med. 1995;11:103–104.
    1. Domenicali M, Caraceni P, Principe A, et al. A novel sodium overload test predicting ascites decompensation in rats with CCl4-induced cirrhosis. J Hepatol. 2005;43:92–97.
    1. Wong F, Liu P, Blendis L. The mechanism of improved sodium homeostasis of low-dose losartan in preascitic cirrhosis. Hepatology. 2002;35:1449–1458.
    1. Arroyo V, Rodés J, Gutiérrez-Lizárraga MA, Revert L. Prognostic value of spontaneous hyponatremia in cirrhosis with ascites. Am J Dig Dis. 1976;21:249–256.
    1. Ginès P, Jiménez W. Aquaretic agents: a new potential treatment of dilutional hyponatremia in cirrhosis. J Hepatol. 1996;24:506–512.
    1. Sterns RH. Severe symptomatic hyponatremia: treatment and outcome. A study of 64 cases. Ann Intern Med. 1987;107:656–664.
    1. Reynolds TB, Lieberman FL, Goodman AR. Advantages of treatment of ascites without sodium restriction and without complete removal of excess fluid. Gut. 1978;19:549–553.
    1. Gauthier A, Levy VG, Quinton A, et al. Salt or no salt in the treatment of cirrhotic ascites: a randomised study. Gut. 1986;27:705–709.
    1. Desai HG. Salt restriction in ascites with cirrhosis of liver: will enhanced salt restriction increase longevity? J Assoc Physicians India. 2006;54:504.
    1. Qiu ZG. Hyponatremia of cirrhotic ascites. J Clin Hepatobiliary Dis. 1994;10:165–166.
    1. Gu XB. 36 cases of acute low sodium syndrome complicated by cirrhotic ascites. J Sino-Jpn Friendsh Hosp. 2000;14:192.
    1. Wong F, Blendis L. New challenge of hepatorenal syndrome: prevention and treatment. Hepatology. 2001;34:1242–1251.
    1. Liu JJ, Zhi H. Disadvantage of sodium restriction in the treatment of cirrhotic ascites and measures. New Med. 2003;34:123.

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