Long-term administration of isosorbide-5-mononitrate does not impair renal function in cirrhotic patients

✍ Scribed by F Salerno; G Borroni; E Lorenzano; D Solenghi; M Cazzaniga; F Bissoli; R Ceriani; R deFranchis

• Publisher: John Wiley and Sons
• Year: 1996
• Tongue: English
• Weight: 178 KB
• Volume: 23
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.510230530

✦ Synopsis

duce hypotension and sodium retention in patients with Isosorbide-5-mononitrate (Is-5-Mn), alone or comascites. (HEPATOLOGY 1996;23:1135-1140.) bined with b-blockers, has been proposed for prophylaxis of variceal bleeding in cirrhosis. However, renal insufficiency, might be an important undesirable effect Isosorbide-5-mononitrate (Is-5-Mn) reduces hepatic of this therapy, especially in patients with ascites. We vascular resistance and portal pressure in cirrhotic livassessed the changes in renal function induced in 26 ers, without affecting hepatic blood flow or liver funccirrhotic patients by acute or chronic administration of tion 1-3 and, when administered for a long period, is able Is-5-Mn. The acute administration of 20 mg of Is-5-Mn to to reduce azygos blood flow. 4 Is-5-Mn also enhances the 21 patients reduced mean blood pressure (83.4 { 2.4 vs. beneficial effect of propranolol on portal hyperten-92.8 { 3.4 mm Hg, P õ .001), urine volume (5.5 { 0.8 vs. sion. 5,6 Recent studies have shown that Is-5-Mn is able 8.7 { 1.1 mL/min, P õ .05), urine sodium excretion (114 to reduce the incidence of first episodes of bleeding from { 19 vs. 244 { 41 mEq/min, P õ .001), urine potassium esophageal varices when given alone 7 or to reduce the excretion (41 { 3.4 vs. 67 { 8.5 mEq/min, P õ .001), and rate of rebleeding when given during a course of scleroatrial natriuretic factor (74 { 10 vs. 98 { 12 pg/mL, P

õ .005). The glomerular filtration rate was decreased in therapy. 8 It is to be expected that Is-5-Mn will be used, the 11 patients with ascites (57 { 9 vs. 68 { 12 mL/min, alone or combined with b-blockers, in future trials on P õ .05), and plasma renin activity was increased in 4 patients with portal hypertension. Salmeron et al., 9 ascitics. Twenty-one patients (16 from the acute study however, reported that a single oral dose of Is-5-Mn / 5 other patients) were given Is-5-Mn for 3 months at stimulates the renin-aldosterone system and impairs the dose of 80 mg/d. This did not affect blood pressure the renal function of cirrhotic patients. Vorobioff et al. 10 and renal function in patients without ascites, but reshowed that long-term administration of isosorbide diduced mean blood pressure (91.9 { 3.4 vs. 89.6 { 3 mm nitrate in combination with propranolol impaired the Hg, P õ .05), urine volume (5.8 { 1.1 vs. 3.4 { 0.9 mL/min, sodium metabolism of a few patients with ascites who P õ .05), and urine sodium excretion (205 { 38 vs. 99 { needed higher doses of diuretics. On the contrary, nei-16 mEq/min, P õ .01) in those with ascites. There were ther Morillas et al. 11 nor Merkel et al. 12 observed any no changes in glomerular filtration rate and renal detrimental effects on renal function after 3 or 6 plasma flow, while plasma renin activity increased in only 3 patients with ascites and 1 without.

months of therapy with a combination of Is-5-Mn and Systemic hemodynamics and renal function of cirb-blockers. These studies make it uncertain whether rhotic patients, especially those with ascites, are afor not long-term administration of a nitrate compound fected adversely by acute administration of Is-5-Mn. alone is beneficial or detrimental for cirrhotic patients. Long-term administration of the drug is well tolerated This question prompted us to investigate the effects of by compensated patients and does not affect renal both acute and chronic administration of Is-5-Mn on plasma flow nor glomerular filtration rate, but can inblood pressure, renal function, and hormones of cirrhotic patients with and without ascites.