Long-term effect of nadolol or nadolol plus isosorbide-5-mononitrate on renal function and ascites formation in patients with cirrhosis

Carlo Merkel, Angelo Gatta, Carlo Donada, Edda Enzo, Renato Marin, Piero Amodio, Pierluigi Torboli, Paolo Angeli, Giorgio Cavallarin, Giuliana Sebastianelli, Sara Susanna, Cesare Mazzaro, Pietro Beltrame

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Abstract

The association beta-blockers plus nitrates has been reported to impair renal function and renal sodium handling, leading to increased risk of development of ascites, or worsening of a preexisting ascites, or increase in the requirements of diuretic agents. In 81 patients with cirrhosis and esophageal varices, participating in a multicenter controlled clinical trial of prophylaxis of variceal bleeding comparing nadolol (NAD) plus isosorbide-5-mononitrate (I5M) with NAD alone, renal function, presence of ascites, and diuretic requirements were assessed at inclusion and after 6 months of follow-up. No significant variation in s-urea or s-creatinine was observed in either group. Three patients in the nadolol group and two in the NAD plus I5M developed ascites at 6 months (P = .70), and a need to increase diuretic regimen was observed in four and three patients, respectively (P = .76). Decrease in heart rate and in mean arterial pressure was similar in the two groups. There was a significant correlation between increase in s-creatinine and decrease in mean arterial pressure in the whole series (P = .015). Only in patients treated with the association was there a significant larger proportion of patients ascitic who became anascitic, than of patients anascitic who became ascitic (P = .03). In patients treated with the association, there was a significantly larger decrease in hepatic venous pressure gradient (P = .05). It is concluded that patients treated with the association NAD plus I5M are not at increased risk of developing renal dysfunction or worsening of ascites compared with patients treated with NAD alone. Therefore, the presence of ascites should not be considered a contraindication to the use of this association in patients with cirrhosis and portal hypertension.

Original languageEnglish
Pages (from-to)808-813
Number of pages6
JournalHepatology
Volume22
Issue number3
DOIs
Publication statusPublished - 1995

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isosorbide-5-mononitrate
Nadolol
Ascites
Fibrosis
Kidney
Diuretics
Creatinine
Arterial Pressure
Venous Pressure
Esophageal and Gastric Varices
Controlled Clinical Trials
Portal Hypertension

ASJC Scopus subject areas

  • Hepatology

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Long-term effect of nadolol or nadolol plus isosorbide-5-mononitrate on renal function and ascites formation in patients with cirrhosis. / Merkel, Carlo; Gatta, Angelo; Donada, Carlo; Enzo, Edda; Marin, Renato; Amodio, Piero; Torboli, Pierluigi; Angeli, Paolo; Cavallarin, Giorgio; Sebastianelli, Giuliana; Susanna, Sara; Mazzaro, Cesare; Beltrame, Pietro.

In: Hepatology, Vol. 22, No. 3, 1995, p. 808-813.

Research output: Contribution to journalArticle

Merkel, C, Gatta, A, Donada, C, Enzo, E, Marin, R, Amodio, P, Torboli, P, Angeli, P, Cavallarin, G, Sebastianelli, G, Susanna, S, Mazzaro, C & Beltrame, P 1995, 'Long-term effect of nadolol or nadolol plus isosorbide-5-mononitrate on renal function and ascites formation in patients with cirrhosis', Hepatology, vol. 22, no. 3, pp. 808-813. https://doi.org/10.1016/0270-9139(95)90301-1
Merkel, Carlo ; Gatta, Angelo ; Donada, Carlo ; Enzo, Edda ; Marin, Renato ; Amodio, Piero ; Torboli, Pierluigi ; Angeli, Paolo ; Cavallarin, Giorgio ; Sebastianelli, Giuliana ; Susanna, Sara ; Mazzaro, Cesare ; Beltrame, Pietro. / Long-term effect of nadolol or nadolol plus isosorbide-5-mononitrate on renal function and ascites formation in patients with cirrhosis. In: Hepatology. 1995 ; Vol. 22, No. 3. pp. 808-813.
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abstract = "The association beta-blockers plus nitrates has been reported to impair renal function and renal sodium handling, leading to increased risk of development of ascites, or worsening of a preexisting ascites, or increase in the requirements of diuretic agents. In 81 patients with cirrhosis and esophageal varices, participating in a multicenter controlled clinical trial of prophylaxis of variceal bleeding comparing nadolol (NAD) plus isosorbide-5-mononitrate (I5M) with NAD alone, renal function, presence of ascites, and diuretic requirements were assessed at inclusion and after 6 months of follow-up. No significant variation in s-urea or s-creatinine was observed in either group. Three patients in the nadolol group and two in the NAD plus I5M developed ascites at 6 months (P = .70), and a need to increase diuretic regimen was observed in four and three patients, respectively (P = .76). Decrease in heart rate and in mean arterial pressure was similar in the two groups. There was a significant correlation between increase in s-creatinine and decrease in mean arterial pressure in the whole series (P = .015). Only in patients treated with the association was there a significant larger proportion of patients ascitic who became anascitic, than of patients anascitic who became ascitic (P = .03). In patients treated with the association, there was a significantly larger decrease in hepatic venous pressure gradient (P = .05). It is concluded that patients treated with the association NAD plus I5M are not at increased risk of developing renal dysfunction or worsening of ascites compared with patients treated with NAD alone. Therefore, the presence of ascites should not be considered a contraindication to the use of this association in patients with cirrhosis and portal hypertension.",
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AU - Merkel, Carlo

AU - Gatta, Angelo

AU - Donada, Carlo

AU - Enzo, Edda

AU - Marin, Renato

AU - Amodio, Piero

AU - Torboli, Pierluigi

AU - Angeli, Paolo

AU - Cavallarin, Giorgio

AU - Sebastianelli, Giuliana

AU - Susanna, Sara

AU - Mazzaro, Cesare

AU - Beltrame, Pietro

PY - 1995

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N2 - The association beta-blockers plus nitrates has been reported to impair renal function and renal sodium handling, leading to increased risk of development of ascites, or worsening of a preexisting ascites, or increase in the requirements of diuretic agents. In 81 patients with cirrhosis and esophageal varices, participating in a multicenter controlled clinical trial of prophylaxis of variceal bleeding comparing nadolol (NAD) plus isosorbide-5-mononitrate (I5M) with NAD alone, renal function, presence of ascites, and diuretic requirements were assessed at inclusion and after 6 months of follow-up. No significant variation in s-urea or s-creatinine was observed in either group. Three patients in the nadolol group and two in the NAD plus I5M developed ascites at 6 months (P = .70), and a need to increase diuretic regimen was observed in four and three patients, respectively (P = .76). Decrease in heart rate and in mean arterial pressure was similar in the two groups. There was a significant correlation between increase in s-creatinine and decrease in mean arterial pressure in the whole series (P = .015). Only in patients treated with the association was there a significant larger proportion of patients ascitic who became anascitic, than of patients anascitic who became ascitic (P = .03). In patients treated with the association, there was a significantly larger decrease in hepatic venous pressure gradient (P = .05). It is concluded that patients treated with the association NAD plus I5M are not at increased risk of developing renal dysfunction or worsening of ascites compared with patients treated with NAD alone. Therefore, the presence of ascites should not be considered a contraindication to the use of this association in patients with cirrhosis and portal hypertension.

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