Efficacy of Combination Therapy with Natriuretic and Aquaretic Drugs Compared to A Conventional Diuretic Therapy as Treatment of Cirrhotic Patients with Ascites and Hyponatremia: An Evidence based Case Report

Introduction: Cirrhotic patients with ascites and hyponatremia have a poor quality of life and high mortality. Classic diuretics such as furosemide and aldosterone antagonists spironolactone improve water retention and edema, but exacerbate hyponatremia in cirrhotic patients. Case illustration: 62 years old male presented to our hospital with severe abdominal pain and severe hyponatremia caused by cirrhosis hepatic. The patient already treated with a conventional diuretic therapy. We would like to investigate the efficacy between conventional diuretic therapy with natriuretic only and combination therapy with natriuretic and aquaretic drugs in treatment of our patient. Method: We search article in PubMed and Proquest, we found 3 eligible Randomized-Controlled Trial (RCT). We do critical appraisal using Center of Evidence-Based Medicine (CEBM) tool from Oxford University. Result: In three trial study, compared to a conventional therapy with only natriuretic drugs, a combination therapy with natriuretic and aquaretic drugs is more effective for patients with cirrhotic ascites. The six-month survival may be improved in cirrhotic patients with hyponatremia after tolvaptan short administration, Conclusion: combination therapy with natriuretic and aquaretic drugs is more effective compered to conventional therapy with only natriuretic drugs for patients with cirrhotic ascites