TY - JOUR

T1 - Effects and safety of natriuretic peptides as treatment of cirrhotic ascites

T2 - A systematic review and meta-analysis

AU - Gantzel, Rasmus Hvidbjerg B.

AU - Kjær, Mikkel Breinholt

AU - Jepsen, Peter

AU - Aagaard, Niels Kristian

AU - Watson, Hugh Robert

AU - Gluud, Lise Lotte

AU - Grønbæk, Henning

PY - 2022/4

Y1 - 2022/4

N2 - BACKGROUNDNatriuretic peptides are involved in the cascade of pathophysiological eventsoccurring in liver cirrhosis, counterbalancing vasoconstriction and anti-natriuretic factors. The effects of natriuretic peptides as treatment of cirrhotic ascites have been investigated only in small studies, and definitive results are lacking.AIMTo examine the effects and safety of natriuretic peptides in cirrhosis patients with ascites.METHODSWe searched MEDLINE, Web of Science, Scopus, Cochrane Library and Embasefor all available studies applying intravenous administration of any natriureticpeptide to patients suffering from cirrhotic ascites. Inclusion was not limited bytreatment duration or dose, or by follow-up duration. Both randomised controlled trials and non-randomised studies were eligible for inclusion. The primary outcome was change in renal sodium excretion. Secondary outcomes included safety measures and changes in renal water excretion, plasma aldosterone concentration, and plasma renin activity.RESULTSTwenty-two studies were included. Atrial natriuretic peptide (ANP) was the onlyintensively studied treatment. Sodium excretion increased in response to continuous ANP infusion and was more pronounced when infusion rates of > 30 ng/kg/min were administered compared with ≤ 30 ng/kg/min (P < 0.01). Moreover, natriuresis was significantly higher in study subgroups with mild/moderate ascites compared with moderate/severe and refractory ascites (P < 0.01). ANP infusions increased renal water excretion, although withoutreaching a statistically significant dose-response gradient. Plasma aldosterone concentration and plasma renin activity were significantly lower at baseline in study subgroups achieving a negative sodium balance in response to an ANP administration compared with treatment non-responders (P < 0.01). Blood pressure decreases occurred less frequently when ANP doses ≤ 30 ng/kg/minwere applied. The quality of evidence for a natriuretic response to ANP was low, mainly due to small sample sizes and considerable between-study heterogeneity. Data were sparse for the other natriuretic peptides; B-type natriuretic peptide and urodilatin.CONCLUSIONIntravenous ANP infusions increase sodium excretion in patients with cirrhotic ascites. Continuous infusion rates > 30 ng/kg/min are the most effective. However, safety increases with infusion rates ≤ 30 ng/kg/min.

AB - BACKGROUNDNatriuretic peptides are involved in the cascade of pathophysiological eventsoccurring in liver cirrhosis, counterbalancing vasoconstriction and anti-natriuretic factors. The effects of natriuretic peptides as treatment of cirrhotic ascites have been investigated only in small studies, and definitive results are lacking.AIMTo examine the effects and safety of natriuretic peptides in cirrhosis patients with ascites.METHODSWe searched MEDLINE, Web of Science, Scopus, Cochrane Library and Embasefor all available studies applying intravenous administration of any natriureticpeptide to patients suffering from cirrhotic ascites. Inclusion was not limited bytreatment duration or dose, or by follow-up duration. Both randomised controlled trials and non-randomised studies were eligible for inclusion. The primary outcome was change in renal sodium excretion. Secondary outcomes included safety measures and changes in renal water excretion, plasma aldosterone concentration, and plasma renin activity.RESULTSTwenty-two studies were included. Atrial natriuretic peptide (ANP) was the onlyintensively studied treatment. Sodium excretion increased in response to continuous ANP infusion and was more pronounced when infusion rates of > 30 ng/kg/min were administered compared with ≤ 30 ng/kg/min (P < 0.01). Moreover, natriuresis was significantly higher in study subgroups with mild/moderate ascites compared with moderate/severe and refractory ascites (P < 0.01). ANP infusions increased renal water excretion, although withoutreaching a statistically significant dose-response gradient. Plasma aldosterone concentration and plasma renin activity were significantly lower at baseline in study subgroups achieving a negative sodium balance in response to an ANP administration compared with treatment non-responders (P < 0.01). Blood pressure decreases occurred less frequently when ANP doses ≤ 30 ng/kg/minwere applied. The quality of evidence for a natriuretic response to ANP was low, mainly due to small sample sizes and considerable between-study heterogeneity. Data were sparse for the other natriuretic peptides; B-type natriuretic peptide and urodilatin.CONCLUSIONIntravenous ANP infusions increase sodium excretion in patients with cirrhotic ascites. Continuous infusion rates > 30 ng/kg/min are the most effective. However, safety increases with infusion rates ≤ 30 ng/kg/min.

KW - atrial natriuretic peptide

KW - B-type natriuretic peptide

KW - Urodilatin

KW - Cirrhosis

KW - Ascites

KW - Refractory ascites

KW - Ascites

KW - Atrial natriuretic peptide

KW - B-type natriuretic peptide

KW - Cirrhosis

KW - Refractory ascites

KW - Urodilatin

U2 - 10.4254/wjh.v14.i4.827

DO - 10.4254/wjh.v14.i4.827

M3 - Journal article

C2 - 35646272

VL - 14

SP - 827

EP - 845

JO - World Journal of Hepatology

JF - World Journal of Hepatology

SN - 1948-5182

IS - 4

ER -