Definition and diagnostic criteria of refractory ascites.

Ascites is the most common complication of liver cirrhosis, as its annual incidence, which ranges from 5 to 10%, is higher than other complications of advanced cirrhosis, such as jaundice, hepatic encephalopathy, and gastrointestinal bleeding. Once ascites has appeared, it can be successfully managed in most cases by dietary sodium restriction and diuretic therapy; it is usually reported that 5 to 10% of patients become refractory to medical treatment, due to either insufficient natriuretic response or the development of diuretic-induced side effects. However, these figures are derived from controlled clinical studies in selected patient populations, and the true incidence of refractory ascites remains unsettled. It is likely that it varies considerably in relation to the stage of cirrhosis, being far greater in patients with impaired glomerular filtration rate.