Empagliflozin in Patients With Cirrhosis and Ascites

Inclusion Criteria:

1. Patients with cirrhosis and ascites on a stable dose of diuretics (spironolactone +/- loop-diuretics based on AASLD guidelines)10 and who do not require large volumeparacenteses

2. eGFR >= 30mL/min/1.73 m2

3. >=18 years old

Exclusion Criteria:

1. Hospitalization due to a complication of cirrhosis in the previous 8 weeks (e.g.variceal hemorrhage, encephalopathy, acute kidney injury, spontaneous bacterialperitonitis)

2. Direct bilirubin >=3 mg/dL

3. Systolic blood pressure < 100 mmHg

4. Active malignancy including hepatocellular carcinoma undergoing treatment

5. History of bladder dysfunction, incontinence, pyelonephritis, urosepsis, or frequenturinary tract infections

6. Use of SGLT-2 inhibitors in the last 10 days, or previous use with intolerance

7. Type 1 diabetes

8. History of frequent hypoglycemic episodes

9. Use of a non-loop diuretic aside from aldosterone antagonists or amiloride as theyare not standard of care in patients with cirrhosis and could potentially increasethe risk of hypovolemia when combined with the standard treatment for ascites alongwith SGLT2 inhibitor.

10. Hepatic hydrothorax requiring thoracentesis in the prior 8 weeks

11. Hepatic encephalopathy grade II or greater at the time of enrollment

12. Patients who have had TIPS placed

13. Previous liver transplant

14. Participation in another trial with an investigational drug within the 30 days priorto informed consent

15. Pregnancy or breastfeeding

16. Inability to give written informed consent or follow study protocol (e.g.clinically-significant psychiatric, addictive, or neurological disease)

17. Change in diuretic dose in the prior 2 weeks

18. Patients with hospitalization for alcoholic hepatitis in the past 6 months

19. Significant worsening of creatinine (more than 50% increase) in the past 4 weeks

20. MELD-Na > or equal to 20

21. Hemoglobin <8