Ascitic fluid filtration and intravenous infusion versus total-volume paracentesis with infusion of plasma expander in cirrhosis with tense or intractable ascites.
BACKGROUND
Patients with cirrhotic ascites have low serum albumin levels, and paracentesis of ascitic fluid could compromise them further.


OBJECTIVE
We compared the therapeutic efficacy of ascitic fluid filtration and concentrate infusion (AFI) versus total-volume paracentesis (TVP) with colloid infusion in control of tense or intractable cirrhotic ascites.


METHODS
Ten patients underwent AFI; their ascitic fluid was filtered repeatedly through hollow-fiber hemodialyzer, and the concentrate reinfused intravenously. In ten patients TVP was done with simultaneous intravenous colloid infusion. Follow-up was done weekly and the study terminated if the patient needed diuretics or developed complications.


RESULTS
Pre-study parameters were similar in the two groups. In the AFI and TVP groups, the duration of procedure was median 12 hours and 5.5 hours; fluid removed by paracentesis was 10.2 L and 8.0 L, respectively; and fluid infused intravenously was 0.5 L [with mean (SD) protein content 5.7 (1.3) g/dl] and 1.1 L, respectively. Glomerular filtration rates were lower than normal in the two groups but did not change significantly with the procedure; body weight remained significantly lower up to week 3 and week 2, respectively. The study was terminated at median week 3 (range 1-8) and week 2 (1-4), respectively. Fever was an accompaniment of AFI and one patient developed peritonitis.


CONCLUSIONS
Patients undergoing AFI remained diuretic-free longer; the procedure is cost-effective but needs to be further evaluated to minimize the side-effects.
Department of Gastroenterology, K E M Hospital, Mumbai.
N N
NN
Mehta
P
P
Abraham
V J
VJ
Ashar
S S
SS
Shikare
S S
SS
Savant
D R
DR
Karnad
F P
FP
Mistry
D001201:Ascites / Q000209:etiology / Q000628:therapy*; D001835:Body Weight; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D019152:Paracentesis; D010952:Plasma Substitutes / Q000008:administration & dosage; D011097:Polygeline / Q000008:administration & dosage; D011897:Random Allocation; D018709:Statistics, Nonparametric; D014462:Ultrafiltration / Q000379:methods*
D010952:Plasma Substitutes; D011097:Polygeline