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The diagnosis of refractory ascites requires the demonstration of diuretic non\u2010responsiveness, despite dietary sodium restriction, or the presence of diuretic\u2010related complications. Patients with refractory ascites require second\u2010line treatments of repeat large\u2010volume paracentesis (LVP) or the insertion of a transjugular intrahepatic portosystemic shunt (TIPS), and assessment for liver transplantation. Careful patient selection is paramount for TIPS to be successful as a treatment for ascites. Patients not suitable for TIPS insertion should receive LVP. The use of albumin as a volume expander is recommended for LVP of &gt;5\u20136\u2003L to prevent the development of circulatory dysfunction, although the clinical significance of post\u2010paracentesis circulatory dysfunction is still debated. Significant mortality is still being observed in cirrhotic patients with ascites and relatively preserved liver and renal function, as indicated by a lower Model for End\u2010Stage Liver Disease (MELD) score. It is proposed that patients with lower MELD scores and ascites should receive additional points in calculating their priority for liver transplantation. Potential new treatment options for ascites include the use of various vasoconstrictors, vasopressin V<jats:sub>2<\/jats:sub> receptor antagonists, or the insertion of a peritoneo\u2010vesical shunt, all of which could possibly improve the management of ascites.<\/jats:p>","DOI":"10.1111\/j.1440-1746.2011.06925.x","type":"journal-article","created":{"date-parts":[[2011,9,15]],"date-time":"2011-09-15T03:58:26Z","timestamp":1316059106000},"page":"11-20","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["Management of ascites in cirrhosis"],"prefix":"10.1111","volume":"27","author":[{"given":"Florence","family":"Wong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2011,12,21]]},"reference":[{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2005.10.013"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2006.08.007"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpg.2006.07.012"},{"key":"e_1_2_9_5_2","doi-asserted-by":"publisher","DOI":"10.1517\/14656566.2011.549126"},{"key":"e_1_2_9_6_2","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2003.50315"},{"key":"e_1_2_9_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.22853"},{"key":"e_1_2_9_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840190113"},{"key":"e_1_2_9_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2006.06.005"},{"key":"e_1_2_9_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(03)00188-0"},{"key":"e_1_2_9_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2008.176495"},{"key":"e_1_2_9_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197006182822502"},{"key":"e_1_2_9_13_2","first-page":"212","article-title":"Urinary sodium\/potassium ratio on random sample as a useful tool to assess diuretic\u2010induced natriuresis on chronic liver disease\u2010associated ascites","volume":"102","author":"Pinto\u2010Marques P","year":"2007","journal-title":"Am. 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