Es la restricción de sal beneficiosa en pacientes con ascitis secundaria a cirrosis?

BACKGROUND:

Salt restriction is recommended by many experts and guidelines for the management of ascites in cirrhosis. However, salt restriction is difficult to achieve and excesive salt restriction can increase the risk of hepatorenal syndrome. Epistemonikos ultrarapid reviews are conducted when no systematic reviews are found in Epistemonikos (a database that systematically searchs for systematic reviews in 24 databases), in order to inform clinicians and potential reviewers. Furthermore, there are no ongoing systematic reviews on this topic registered in PROSPERO.

METHODS:

The search was conducted in January 13, 2015. We reviewed 3 clinical practice guidelines addressing management of patients with cirrhosis and ascites (European Association for the Study of the Liver 2010; American Association for the Study of Liver Diseases; Moore et al 2006). We also run a search for primary studies in PubMed using the following strategy combined with the Cochrane Highly Sensitive Search Strategy for identifying randomized trials in MEDLINE (sensitivity-maximizing version [2008 revision]: ("Diet, Sodium-Restricted"[MeSH Terms] OR "Sodium Chloride"[nm] OR salt[ti] OR "salt restriction") AND (cirrho* OR ascit* OR liver OR hepatic*); and we used the 'Related citations' feature in PubMed for each identified study (first 20 hits screened). Finally, we searched for ongoing studies in the WHO International Clinical Trials Registry Platform (ICTRP). We did not attempt to synthesize the studies.

RESULTS:

Four randomised studies were identified (80 to 200 patients). The conclusions of all the guidelines were similar, recommending salt restriction, citing 0 to 2 of the identified studies. None of the guidelines cited the two more recent studies, including the largest one, because they were published afterwards. The individual trials concluded no difference between both alternatives, or superiority of the unrestricted diet.

CONCLUSION:

Current guidelines should update the evidence base for their recommendations on salt restriction in patients with ascites an cirrhosis. A systematic review is urgently needed in this topic.