Open-labeled randomized controlled trial to compare diuretic therapy with recombinant human serum albumin and diuretic therapy for therapeutic treatment of ascites in patients with advanced liver cirrhosis: An exploratory trial

• Published in: Hepatology research 2014-05, Vol.44 (5), p.502-514
• Main Authors: Nakamura, Toru, Sata, Michio, Suzuki, Kazuyuki, Moriwaki, Hisataka, Fukui, Hiroshi, Fujiyama, Shigetoshi, Imawari, Michio
• Format: Article
• Language: English
• Subjects: ascites; KD-294; liver cirrhosis; recombinant human serum albumin
• ISSN: 1386-6346; 1872-034X
• DOI: 10.1111/hepr.12142

Aim There have been only a few trials demonstrating additional effects of human serum albumin (HSA) on diuretic therapy in patients with cirrhotic ascites. We aimed to evaluate the safety and efficacy of recombinant HSA, KD‐294, treatment in patients with cirrhotic ascites. Methods The inclusion criteria were patients 20–75 years of age, with cirrhotic ascites and a serum albumin concentration of less than 3.0 g/dL. Eighty‐five patients were registered and 71 patients underwent randomization. Enrolled patients received oral spironolactone at 50 mg/day and i.v. furosemide at 20 mg/day in addition to low‐sodium diet. They were divided randomly into a KD‐294 treatment group (n = 35) or non‐treatment control group (n = 36). Patients in the KD‐294 group received KD‐294 at 25 g/day for up to 5 days and those in the control group continued the diuretic therapy. They were followed up for 5 weeks. Results KD‐294 was well tolerated. A correlation between the increases in serum albumin and decreases in bodyweight was not shown. However, changes of plasma renin concentration (PRC) showed a significant decrease in the KD‐294 group compared with the control group. As a result of this exploratory analysis, patients with high PRC showed a significant correlation between increases in serum albumin and decreases in bodyweight. Conclusion The present data do not show efficacy in all patients with cirrhotic ascites, however, they suggest that additional effects of HSA on diuretic therapy are expected in high PRC patients.