Diuretic therapy and ascitic fluid pattern in heart failure

ABSTRACT

It is claimed that diuretics can change the pattern of ascitic fluid analysis in heart failure, but, it has remained a controversial issue. To test the hypothesis that in heart failure diuretics change the transudative pattern of ascites to exudative. In a prospective study, 50 patients [32 male, 18 female] with a mean age of 49 years [range, 26-67 years], and ascites secondary to heart failure were randomly allocated to two therapeutic groups. Group I 30 patients received furosemide and group II 20 patients received triamtrene H for two weeks. Abdominal paracentesis was performed before, and one and two weeks after diuretic therapy. The difference in ascitic fluid total protein [AFTP] and cell count was not significant at baseline between the two groups. In patients on furosemide, the change in AFTP compared to the baseline was significant [p<0.001 and p<0.001, respectively] one and two weeks after therapy. In patients on triamtrene H, the change in AFTP one and two weeks after therapy compared to the baseline was significant [p<0.01 and p<0.001, respectively]; ascitic fluid met exudative criteria in three patients [15%]. In group I patients, the difference in ascitic fluid cell count, one and two weeks after therapy was statistically significant [p<0.001 and p<0.001 respectively] compared to the baseline. In group II, the difference in ascitic fluid cell count one and two weeks after therapy compared to the baseline was not significant. In group I 23 patients [76.6%] showed a significant change in their ascitic fluid pattern while in group II 3 patients [15%] showed ascitic fluid changes toward the exudative pattern [p<0.05]. In patients with heart failure, furosemide changes transudative ascitic to exudative; the change is more significant in the amount of protein than in the cell count, and occurs at the end of the first week of therapy and continues thereafter