Refractory Ascites in Patients With Liver Cirrhosis, and the Potential Treatment With 48 Hours Infusion of Ularitide.

Inclusion Criteria: * Men and women \>18 years * Liver cirrhosis confirmed by fibroscan (\>20 kPa), or by imaging with signs of an irregular liver surface with collaterals, or clinically by cirrhosis stigmata * Refractory ascites Definition: failure to respond to or intolerance to high dose diuretics (spironolactone up to 400mg/day and furosemide up to 160mg/day) and early ascites recurrence (reappearance of grade 2 or 3 ascites within 4 weeks of initial mobilization or ≥2 paracentesis within last 3 months) * Urine sodium excretion \<60 mmol/24 hour * Serum creatinine \<150 µmol/L * Child-Turcotte-Pugh score of B or C (\<13) * Bilirubin \<150 µmol/L * Prothrombin time (PP) 0.20-0.60 (INR 1.3-2.5) * Systolic blood pressure ≥95 mmHg * Written informed consent to participate in the clinical trial Exclusion Criteria: * Gastrointestinal bleeding within 2 weeks prior to inclusion * Proteinuria \>500 mg/day * Hemoglobin \<5.5 mmol/L * Spontaneous bacterial peritonitis within 2 weeks prior to inclusion * Loculated ascites * Hepatic encephalopathy grade 2-4 (West-Haven classification) * Obstructive uropathy * Primary kidney disease * Known diagnosis of congestive heart failure * Known diagnosis of acute-on-chronic liver failure * Known diagnosis of systemic inflammatory response syndrome * Acute infections by known diagnosis and/or antibiotic treatment * Known HIV infection * Known allergy to the investigational drug or other natriuretic peptides * Treatment with dobutamine, levosimendan, milrinone, any phosphodiesterase inhibitor, octreotide, midodrine, vasopressin, dopamine or other vasopressors within 2 weeks prior to inclusion * Nephrotoxic drugs within 1 month prior to inclusion * Fertile women not using contraception, either an intrauterine device or hormonal contraception * Positive pregnancy test in pre-menopausal women or in breast-feeding women * Participation in an interventional clinical drug trial within 1 month prior to inclusion * Legal incapacity or limited legal capacity * Patients who are employees or relatives of the investigator