Table 5.

Definition and diagnostic criteria for refractory ascites in cirrhosis [112]

	Definition
Diuretic-resistant ascites	Ascites that cannot be mobilized or the early recurrence of which cannot be prevented because of a lack of response to sodium restriction and diuretic treatment
Diuretic-intractable ascites	Ascites that cannot be mobilized or the early recurrence of which cannot be prevented because of the development of diuretic-induced complications that preclude the use of an effective diuretic dosage
Requisites
Treatment duration	Intensive diuretic therapy (spironolactone 400 mg/day and furosemide 160 mg/day) for at least 1 week and on a salt-restricted diet of less than 5 g/day
Response of therapy	Mean weight loss of <800 g over 4 days and urinary sodium output less than the sodium intake
Early ascites recurrence	Recurrence of grade 2-3 ascites within 4 weeks of initial mobilization
Diuretic-induced complications	Hepatic encephalopathy: development of encephalopathy in the absence of any other precipitating factor
	Renal impairment: >0.3 mg/dL increase of sCr within 48 hours of baseline or 1.5-fold increase within 1 week
	Hyponatremia: decrease of serum sodium by >10 mEq/L to serum sodium of <125 mEq/L
	Hypo- or hyperkalemia: change in serum potassium to <3 mmol/L or >6 mmol/L

sCr, serum creatinine.