A study to evaluate the efficacy of SGLT2 inhibitor (Empagliflozin) as an adjunctive to SoC therapy in the management of refractory ascites in Cirrhosis

Ascites is the most common complication of cirrhosis, continued up to 60% of the patients with a 10 years of diagnosis.  Among these 5 to 10% develop refractory ascites, defined as ascites that cannot be mobilized or recur rapidly despite dietary sodium restriction and maximal diuretic therapy.  If there is a worse prognosis with median survival of less than 6 months.  Current treatment plan diuretics include large-volume paracentesis, TIPS, vasoconstrictor therapy albumin infusions and diuretics.  However these approaches of limitation such as procedure complication, recurrence of ascites and cost issues.  Sodium glucose Co. transporter 2 (SGLT-2) inhibitors are relatively new class of antihyperglycemic agents have been shown to be renal protective and cardioprotective benefits beyond glycemic control.  They are not benefiting glucose and sodium reabsorption in the proximal and ventricular producing osmotic diuresis natriuresis independent of aldosterone.  This mechanism evaluation and patient with cirrhosis and ascites, with activation of the renin-angiotensin-aldosterone system aortic distance may have sclerosing pathophysiology.