Patients with cirrhosis and ascites had improved renal perfusion and long-term outcomes when switched from propranolol to carvedilol, according to the results of a study published in the Journal of Clinical Gastroenterology.
The single-center, prospective trial included 96 patients diagnosed with cirrhosis and ascites who were already established on propranolol for esophageal varices bleeding prophylaxis. Participants were randomly assigned 2:1 to receive carvedilol 12.5 mg per day or continue on propranolol.
The primary outcomes included liver-related survival and the occurrence of a decompensating event. Variceal bleeding, hepatorenal syndrome, hepatic encephalopathy, spontaneous bacterial peritonitis, and the reappearance of ascites all constituted a decompensating event. Secondary outcomes assessed systemic hemodynamics, such as mean arterial pressure and systemic vascular resistance, and renal hemodynamics, such as glomerular filtration rate and effective renal plasma flow.
The average age of patients in the carvedilol and propranolol groups were 55.1 and 54.2 years and 75% and 67.6% were men, respectively. Baseline characteristics did not vary significantly between groups.
Patients in the carvedilol group were significantly less likely to have suffered liver-related death at the 2-year follow-up compared with the propranolol group (12% vs 37.5%; P =.02). Decompensating events were also significantly less likely in the carvedilol treatment arm compared with the propranolol treatment arm (10.3% vs 37.5%; P =.002). Mean arterial pressure, systemic vascular resistance, and glomerular filtration rate were all improved in patients converted to carvedilol.
The study utilized strict inclusion criteria, which may limit the applicability of the results to a larger patient population. Additional research is needed to better comprehend the hemodynamic impact and safety of using nonselective beta-blockers in a broader collection of patients with ascites.
Kalambokis G, Christaki M, Tsiakas I, et al. Conversion of propranolol to carvedilol improves renal perfusion and outcome in patients with cirrhosis and ascites. J Clin Gastroenterol. 2021;55(8):721–729. doi: 10.1097/MCG.0000000000001431