Treatment of Portal Hypertension with Refractory Diuretic-Resistant Ascites in Cirrhosis

In patients with cirrhosis and portal hypertension, ascites may progress to a state where it no longer responds adequately to intensive diuretic therapy — a condition that requires a distinct clinical approach.

        Defining this scenario: Diuretic-resistant ascites is characterised by a mean weight loss of less than 0.8 kg over 4 days and urinary sodium below sodium intake, despite intensive diuretic therapy maintained for at least one week in a patient with cirrhosis.
      

Clinical Goals

Control of ascites
Improvement in renal function

Management Approach

The approach in this setting involves a procedural intervention to relieve ascites combined with pharmacological therapy targeting circulatory and renal complications — the full evidence-based regimen, including agent selection and sequencing, is available in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jceh.2022.03.002

A mean weight loss of <0.8 kg over 4 days and urinary sodium less than sodium intake in a patient with cirrhosis on intensive diuretic therapy (furosemide 160 mg/day and spironolactone 400 mg/day) for at least one week is termed as diuretic resistant ascites.

Large-volume paracentesis with albumin is the recommended therapy to prevent paracentesis-induced circulatory dysfunction.

Terlipressin administration for a brief period of 3 weeks can improve ascites control and renal function and is suggested as an excellent non-transplant therapy.

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