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Volume 351:300-301 July 15, 2004 Number 3
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Management of Cirrhosis and Ascites

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by Ginès, P.
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To the Editor: In their review article, Ginès et al. (April 15 issue)1 state that in patients with large-volume ascites, the "serum creatinine concentration is normal or only moderately higher than normal, indicating that the glomerular filtration rate is normal or only moderately reduced." We disagree with this statement because the serum creatinine concentration overestimates the glomerular filtration rate in patients with cirrhosis and has a much lower sensitivity (18.5 percent) than the creatinine clearance (sensitivity, 74.0 percent) or the inulin clearance for the detection of renal failure.2

Over a three-year period at our institution, 8 of 43 patients (19 . . . [Full Text of this Article]



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