Sodium Restriction in the Management of Cirrhotic Ascites

Comparison of Efficacy of 2 Gram Versus 4 Gram Sodium Restriction in the Management of Cirrhotic Ascites

To determine the relationship between degree of sodium restriction and dietary compliance with clinical outcome of diuresis of portal hypertensive ascites in cirrhotic patients from a county hospital population.

Primary objective: Demonstrate that, when accompanied by the appropriate diuretic regimen, a No Added Salt diet (4 grams sodium per day) is as effective as a Low Sodium diet (2 grams sodium per day) in the management of cirrhotic ascites.

Secondary objectives:

1. Demonstrate that patient acceptance is greater and diuresis faster with a No Added Salt diet compared with a Low Sodium diet
2. Demonstrate that side-effects of diuretic therapy are the same or less when patients are on a No Added Salt diet
3. Determine if glomerular filtration rate estimated from the modified diet in renal disease equation differs from that obtained by a 24 hour urinary creatinine in patients with cirrhotic ascites

Inclusion Criteria:

• Cirrhotic patients of any etiology with ascites from portal hypertension diagnosed by paracentesis,
• Age 18-75
• Clinical or radiographic (abdominal CT or ultrasound) estimate of moderate - severe ascites
• Spanish-speaking subjects will be eligible for participation

Exclusion Criteria:

• Active drug or alcohol abuse,
• Active complications of SBP, hepatic encephalopathy, or GI bleed within 2 weeks,
• Hemorrhagic ascites, malignant ascites,
• Creatinine >2 mg/dL or CCl < 30 mL/min,
• K > 5.5 mmol/L,
• Diuretic refractory ascites
• Allergy to or intolerance of either spironolactone or furosemide
• Homelessness, incarceration, inability to follow up in clinic, or comply with diet.