Albumin May Prevent the Morbidity of Paracentesis-Induced Circulatory Dysfunction in Cirrhosis and Refractory Ascites: A Pilot Study

Background Large-volume total paracentesis may result in paracentesis-induced circulatory dysfunction, which is associated with poor outcomes. Aims To explore the short- and long-term effects of paracentesis-induced circulatory dysfunction on systemic hemodynamics, renal function and other cirrhosis-related complications in patients with refractory ascites, following subtotal large-volume paracentesis. Methods Patients with cirrhosis and refractory ascites without renal dysfunction had systemic hemodynamics, renal function, and neurohormones (plasma active renin, aldosterone, norepinephrine and angiotensin II) measured pre- and 6 days post-paracentesis. Paracentesis was limited to ≤8 L with 6–8 g of albumin per liter ascites drained. Patients were followed up until transjugular intrahepatic portosystemic shunt insertion, liver transplantation, or death. Paracentesis-induced circulatory dysfunction was defined as >50 % increase in plasma active renin 6 days post-paracentesis. Results Fifty-seven patients (mean age 59.0 ± 9.4 years) had mean 6.8 ± 1.8 L of ascites removed with 9 ± 3 g of albumin given/L of ascites drained. Patients were followed up for 715 ± 104 days. Twenty-three patients (40.4 %) developed paracentesis-induced circulatory dysfunction with unchanged serum creatinine on day six, despite worsening of hemodynamics (mean arterial pressure 90 ± 10 mmHg at baseline vs. 84 ± 8 mmHg on day six, p < 0.05). Similar hemodynamic changes were observed among patients without paracentesis-induced circulatory dysfunction. There was no significant difference in the long-term renal function or cirrhosis-related complications between the groups. Conclusion The occurrence of paracentesis-induced circulatory dysfunction, as defined by plasma active renin, may not have a significant short- and long-term impact on renal function or cirrhosis-related complications in patients with refractory ascites who undergo subtotal paracentesis with albumin infusion..

Medienart:	Artikel

Erscheinungsjahr:	2016
Erschienen:	2016

Enthalten in:	Zur Gesamtaufnahme - volume:61
Enthalten in:	Digestive diseases and sciences - 61(2016), 10 vom: 05. Apr., Seite 3084-3092

Sprache:	Englisch

Beteiligte Personen:	Tan, Hiang Keat [VerfasserIn] James, Paul Damien [VerfasserIn] Wong, Florence [VerfasserIn]

Links:	Volltext [lizenzpflichtig]

Themen:	Ascites Cirrhosis Large-volume paracentesis Paracentesis-induced circulatory dysfunction Renal failure

Anmerkungen:	© Springer Science+Business Media New York 2016

doi:	10.1007/s10620-016-4140-3

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Förderinstitution / Projekttitel:

PPN (Katalog-ID):	OLC202724736X