BACKGROUND Natriuretic peptides are involved in the cascade of pathophysiological events occurring in liver cirrhosis,counterbalancing vasoconstriction and anti-natriuretic *** effects of natriuretic peptides as treat...
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BACKGROUND Natriuretic peptides are involved in the cascade of pathophysiological events occurring in liver cirrhosis,counterbalancing vasoconstriction and anti-natriuretic *** effects of natriuretic peptides as treatment of cirrhotic ascites have been investigated only in small studies,and definitive results are *** To examine the effects and safety of natriuretic peptides in cirrhosis patients with *** We searched MEDLINE,Web of Science,Scopus,Cochrane Library and Embase for all available studies applying intravenous administration of any natriuretic peptide to patients suffering from cirrhotic *** was not limited by treatment duration or dose,or by follow-up *** randomised controlled trials and non-randomised studies were eligible for *** primary outcome was change in renal sodium *** outcomes included safety measures and changes in renal water excretion,plasma aldosterone concentration,and plasma renin *** Twenty-two studies were *** natriuretic peptide(ANP)was the only intensively studied *** excretion increased in response to continuous ANP infusion and was more pronounced when infusion rates of>30 ng/kg/min were administered compared with≤30 ng/kg/min(P<0.01).Moreover,natriuresis was significantly higher in study subgroups with mild/moderate ascites compared with moderate/severe and refractory ascites(P<0.01).ANP infusions increased renal water excretion,although without reaching a statistically significant dose-response *** aldosterone concentration and plasma renin activity were significantly lower at baseline in study subgroups achieving a negative sodium balance in response to an ANP administration compared with treatment non-responders(P<0.01).Blood pressure decreases occurred less frequently when ANP doses≤30 ng/kg/min were *** quality of evidence for a natriuretic response to ANP was low,mainly due to small sample size
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