Efficacy of Empagliflozin and Midodrine in refractory ascites

After obtaining written informed consent and checking for exclusion criteria, patients having cirrhosis with refractory ascites as per criteria will be enrolled in the study. Information regarding relevant history, physical examination, demographic and laboratory parameters, grade of ascites, CTP score, MELD score, LFT, RFT will be entered in a preformatted data sheet. Study subjects will be divided into three groups on the basis of the current or planned treatment regimen with monitoring for safety and adverse events for 12 weeks: Empagliflozin group- Participants will receive empagliflozin 10mg oral tablets once daily. Midodrine group- Participants will receive Midodrine 2.5mg oral tablets thrice daily. The dose might be up titrated according to the blood pressure monitoring to maximum dose 12.5 mg three times daily. Empagliflozin and Midodrine group- Participants will receive Midodrine 2.5mg oral tablets thrice daily and empagliflozin 10mg oral tablets once daily.

Once enrolled patients will be followed up at week 4, 8 and 12. Follow up data will be recorded in a pre-designed form and outcomes will be measured. Treatment of empagliflozin will be stopped if patient developed any of the following- Attack of symptomatic hypoglycemia, hypotension not responding vasopressor agent, complicated urinary tract infection or diabetic ketoacidosis). Treatment of midodrine will be stopped if SBP is 140 mmHg.