Conversion of Propranolol to Carvedilol Improves Renal Perfusion and Outcome in Patients With Cirrhosis and Ascites.

Abstract

BACKGROUND:

In recent years, concerns have been raised on the potential adverse effects of nonselective beta-blockers, and particularly carvedilol, on renal perfusion and survival in decompensated cirrhosis with ascites. We investigated the long-term impact of converting propranolol to carvedilol on systemic hemodynamics and renal function, and on the outcome of patients with stable cirrhosis and grade II/III nonrefractory ascites.

PATIENTS AND METHODS:

Ninety-six patients treated with propranolol for esophageal varices' bleeding prophylaxis were prospectively evaluated. These patients were randomized in a 2:1 ratio to switch to carvedilol at 12.5 mg/d (CARVE group; n=64) or continue propranolol (PROPRA group; n=32). Systemic vascular resistance, vasoactive factors, glomerular filtration rate, and renal blood flow were evaluated at baseline before switching to carvedilol and after 6 and 12 months. Further decompensation and survival were evaluated at 2 years.

RESULTS:

During a 12-month follow-up, carvedilol induced an ongoing improvement of systemic vascular resistance (1372±34 vs. 1254±33 dynes/c/cm5; P=0.02) along with significant decreases in plasma renin activity (4.05±0.66 vs. 6.57±0.98 ng/mL/h; P=0.01) and serum noradrenaline (76.7±8.2 vs. 101.9±10.5 pg/mL; P=0.03) and significant improvement of glomerular filtration rate (87.3±2.7 vs. 78.7±2.3 mL/min; P=0.03) and renal blood flow (703±17 vs. 631±12 mL/min; P=0.03); no significant effects were noted in the PROPRA group. The 2-year occurrence of further decompensation was significantly lower in the CARVE group than in the PROPRA group (10.5% vs. 35.9%; P=0.003); survival at 2 years was significantly higher in the CARVE group (86% vs. 64.1%; P=0.01, respectively).

CONCLUSION:

Carvedilol at the dose of 12.5 mg/d should be the nonselective beta-blocker treatment of choice in patients with cirrhosis and nonrefractory ascites, as it improves renal perfusion and outcome.

• Authors: Georgios N Kalambokis, Maria Christaki, Ilias Tsiakas, Grigorios Despotis, Sempastien Fillipas-Ntekouan, Andreas Fotopoulos, Spyridon Tsiouris, Xanthi Xourgia, Lampros Lakkas, Konstantinos Pappas, Lampros K Michalis, Fotini Sergianiti, Gerasimos Baltayiannis, Dimitrios Christodoulou, Christina Koustousi, Nikolaos Aggelis, Haralampos Milionis
• Journal: Journal of clinical gastroenterology (J Clin Gastroenterol) Vol. 55 Issue 8 Pg. 721-729 (09 01 2021) ISSN: 1539-2031 [Electronic] United States
• PMID: 32991355 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Chemical References

• Carvedilol
• Propranolol

Topics

• Ascites (drug therapy)
• Carvedilol
• Humans
• Kidney (physiology)
• Liver Cirrhosis (complications, drug therapy)
• Perfusion
• Propranolol