Impairment of renal function during moderate physical exercise in cirrhotic patients with ascites: Relationship with the activity of neurohormonal systems

✍ Scribed by J Salo; M Guevara; G Fernandez-Esparrach; R Bataller; A Gines; W Jimenez; P Gines; F Rivera; V Arroyo; J Rodes

• Publisher: John Wiley and Sons
• Year: 1997
• Tongue: English
• Weight: 229 KB
• Volume: 25
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.510250606

✦ Synopsis

The treatment of ascites in cirrhosis is based on sodium Moderate physical exercise does not affect glomerular restriction and the administration of diuretics. Bed rest is filtration rate (GFR) and renal excretory function in noralso frequently recommended because the assumption of an mal subjects. This study is aimed at assessing the effects upright posture from supine by patients with ascites is associof moderate physical exercise on renal function in 21 ated with marked stimulation of the renin-aldosterone and nonazotemic cirrhotic patients with ascites. Arterial sympathetic nervous systems and decreased response to dipressure, heart rate, and renal function were assessed uretics. [1][2][3][4] Moderate physical exercise in normal subjects and in the patients after 2 hours in the supine position and in patients with cirrhosis and ascites is also associated with during 30 minutes of moderate cycloergometric exercise significant stimulation of the renin-aldosterone and sympain the sitting position. The activity of the renin-aldosthetic nervous systems. [5][6][7][8][9][10] The mechanism of this, however, terone and sympathetic nervous systems and the plasma is different from that occurring during postural changes.

levels of antidiuretic hormone (ADH) and atrial natri-

Whereas postural changes affect neurohormonal vasoactive uretic peptide (ANP) were determined at the end of each systems through a baroreceptor-mediated mechanism, the period. Physical exercise induced a marked reduction effect of physical exercise is mediated by a central command in GFR (75 { 10 to 49 { 6 mL/min), free-water clearance from brain structures and peripheral muscle mechano-and (6.1 { 1 to 3.4 { 1 mL/min), and sodium excretion (7.8 { chemoreflexes. 11,12 It is well established that moderate physi-2 to 4.3 { 1 mEq/min) in 10 patients (Group I). In the cal exercise does not affect glomerular filtration rate (GFR) remaining 11 cases (Group II) there were no changes in and renal excretory function in normal subjects. 5,8,[13][14][15] Howthese parameters. Renal perfusion significantly deever, no study has been reported in patients with decompencreased in both groups although the reduction was sated cirrhosis. If physical exercise induced a deterioration greater in Group I (034.7% { 4.6% vs. 07.5% { 3.1%, P õ of renal function in these patients, it would further support .001). Physical exercise was associated with a significant bed rest as a therapeutic measure for ascites, especially in and comparable increase in arterial pressure, heart rate, patients responding poorly to diuretics. and plasma levels of renin, aldosterone, and norepineph-Therefore, the aim of the current study is to assess the rine (NE) in the two groups of patients. The ANP conceneffect of moderate physical exercise on renal plasma flow, tration did not change. Patients from Groups I and II GFR, free-water clearance, and urinary sodium excretion in differed significantly (P õ .05) only in plasma renin accirrhotic patients with ascites. tivity (PRA) and NE concentration, which were higher in Group I patients both in the supine rest (renin: 4.7 { PATIENTS AND METHODS 1.6 vs. 1.4 { 0.5 ng/mLrh; NE: 576 { 115 vs. 288 { 42 pg/ mL) and during exercise (renin: 7.1 { 1.8 vs. 2.6 { 1 ng/ This study was approved by the Investigation and Ethics Commit-mLrh; NE: 925 { 135 vs. 630 { 90 pg/mL). In conclusion, tee of the Hospital ClıB nic i Provincial of Barcelona (Barcelona, Spain). moderate physical exercise has no detrimental effects All patients gave informed consent before entering in the study. Twenty-one cirrhotic patients who were admitted to the hospital on renal function in cirrhotic patients with ascites with for the treatment of an episode of ascites were included in the study. no or mild activation of the renin-aldosterone and sym-Diagnosis of cirrhosis was based on liver histology in 16 patients and pathetic nervous systems. However, moderate physical on clinical, laboratory, and ultrasonographic data in the remaining exercise causes a marked impairment in the renal func-5 patients. The etiology of cirrhosis was alcoholic in 9 cases, hepatitis tion of patients with ascites with marked stimulation C virus antibody-associated in 8, hepatitis B surface antigen-asso- of these vasoconstrictor systems. (HEPATOLOGY 1997; ciated in 2, and cryptogenic in 2. All patients with alcoholic cirrhosis 25:1338-1342.)

abstained from alchohol for at least 6 months before the study. The criteria used to admit patients into the study were the following: 1) age under 65 years; 2) absence of gastrointestinal bleeding, hepatic encephalopathy, or bacterial infection in the month previous to the Abbreviations: GFR, glomular filtration rate; PRA, plasma renin activity; ADH, antidistudy; 3) absence of hepatocellular carcinoma; 4) normal serum creaturetic hormone; ANP, atrial natriuretic peptide; NE, norepinephrine.