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Cited by 967Liver Disease and TransplantationLiver Disease Diagnosis and TreatmentHeart Failure Treatment and Management

The Management of Ascites in Cirrhosis: Report on the Consensus Conference of the International Ascites Club

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Moore, Kevin P., Wong, Florence, Gines, Pere, Bernardi, Mauro, Ochs, Andreas, Salerno, Francesco, Angeli, Paolo, Porayko, Michael +5 more·2003·Hepatology
DOI 10.1053/jhep.2003.50315
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Abstract

Ascites is a common complication of cirrhosis, and heralds a new phase of hepatic decompensation in the progression of the cirrhotic process. The development of ascites carries a significant worsening of the prognosis. It is important to diagnose noncirrhotic causes of ascites such as malignancy, tuberculosis, and pancreatic ascites since these occur with increased frequency in patients with liver disease. The International Ascites Club, representing the spectrum of clinical practice from North America to Europe, have developed guidelines by consensus in the management of cirrhotic ascites from the early ascitic stage to the stage of refractory ascites. Mild to moderate ascites should be managed by modest salt restriction and diuretic therapy with spironolactone or an equivalent in the first instance. Diuretics should be added in a stepwise fashion while maintaining sodium restriction. Gross ascites should be treated with therapeutic paracentesis followed by colloid volume expansion, and diuretic therapy. Refractory ascites is managed by repeated large volume paracentesis or insertion of a transjugular intrahepatic portosystemic stent shunt (TIPS). Successful placement of TIPS results in improved renal function, sodium excretion, and general well–being of the patient but without proven survival benefits. Clinicians caring for these patients should be aware of the potential complications of each treatment modality and be prepared to discontinue diuretics or not proceed with TIPS placement should complications or contraindications develop. Liver transplantation should be considered for all ascitic patients, and this should preferably be performed prior to the development of renal dysfunction to prevent further compromise of their prognosis.

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  • A later meta-analysis on long-term salt restriction in people with chronic kidney disease showed no direct effects of sodium restriction on primary endpoints such as mortality and progression to end-stage kidney disease.

    “showed no direct effects of sodium restriction on primary endpoints such as”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [154]

    The “Trials on Sodium Restriction” section reports no significant survival difference between salt-restricted and unrestricted diets in patients with cirrhosis and ascites. It does not report a later meta-analysis of people with chronic kidney disease or an outcome for progression to end-stage kidney disease; a nonsignificant survival difference also does not establish no direct effect. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Salt reduction in people with chronic kidney disease reduced blood pressure considerably and consistently reduced proteinuria.

    “kidney disease, however, reduced blood pressure considerably and consistently reduced”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [154]

    The Sodium and Water Restriction and Trials on Sodium Restriction sections discuss salt restriction for ascites in cirrhosis, not blood pressure or proteinuria in people with chronic kidney disease. Searches for those outcomes and that population found no passage addressing the claim. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 60

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Authors
Moore, K. P., Wong, F., Gines, P., Bernardi, M., Ochs, A., Salerno, F., Angeli, P., Porayko, M., Moreau, R., Garcia-Tsao, G., Jimenez, W., Planas, R., & Arroyo, V.
Affiliations
  • The Royal Free Hospital (GB)
  • University of Toronto (CA)
  • University of Bologna (IT)
  • University of Freiburg (DE)
  • University of Milan (IT)
  • University of Padua (IT)
  • Thomas Jefferson University (US)
  • Inserm (FR)
  • Yale University (US)
  • Hospital Clínic de Barcelona (ES)
Corresponding author
Moore, Kevin P.
ORCID
Venue
Hepatology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2003-07
Volume
38
Issue
1
Pages
258-266
ISSN
0270-9139 (ISSN-L)
DOI
10.1053/jhep.2003.50315
OpenAlex
W2134481878
Cited by
967
References
0
Citations by year
2026: 17 · 2025: 51 · 2024: 48 · 2023: 42 · 2022: 60 · 2021: 46 · 2020: 44 · 2019: 44 · 2018: 44 · 2017: 45 · 2016: 54 · 2015: 41 · 2014: 40 · 2013: 43 · 2012: 42
FWCI
24.44
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 4445 d)
Locations
  • Hepatology (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Padua Research Archive (University of Padova) (submittedVersion)
  • INFM-OAR (INFN Catania) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Keywords
ascites, liver cirrhosis, refractory ascites, therapeutic paracentesis, transjugular intrahepatic portosystemic shunt, diuretic therapy, spironolactone, sodium restriction, liver transplantation, hepatic decompensation
MeSH terms
Ascites, Humans, Liver Cirrhosis, Evidence-Based Medicine

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