title: Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites.
abstract: Paracentesis-induced circulatory dysfunction (PICD) is a recently described complication that can be prevented with the administration of plasma expanders. The aim of this study was to compare the efficacy of saline versus albumin in the prevention of PICD. Patients were randomized to receive albumin or saline after total paracentesis. Patients readmitted as a consequence of a second episode of tense ascites were treated with total paracentesis and the alternative plasma expander. After randomization, 35 patients received saline and 37 received albumin. Twenty-one patients were readmitted for tense ascites and treated with the alternative expander. Significant increases in plasma renin activity (PRA) were found 24 hours and 6 days after paracentesis when saline was used (baseline, 5.6 +/- 5.7; 24 hours, 7.6 +/- 6.9; 6 days, 8.5 +/- 8.0 ng x mL(-1). hr(-1); P <.05 and P <.01 vs. baseline, respectively), whereas no significant changes were observed with albumin. The incidence of PICD was significantly higher in the saline group versus the albumin group (33.3% vs. 11.4%, respectively; P =.03). However, no significant differences were found when less than 6 L of ascitic fluid was evacuated (6.7% vs. 5.6% in the saline and albumin groups, respectively; P =.9). Similar results were observed when analyzing patients who received 2 consecutive paracentesis (i.e., a significant increase in PRA after saline [P <.01] without significant variations after albumin). In conclusion, albumin is more effective than saline in the prevention of PICD. Saline is a valid alternative to albumin when less than 6 L of ascitic fluid is evacuated.
authors.affiliation: Liver Unit, Internal Medicine Department, Hospital General Universitario de Alicante, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Sola-Vera
authors.forename: Josep
authors.initials: J
authors.lastname: Miñana
authors.forename: Elena
authors.initials: E
authors.lastname: Ricart
authors.forename: Montserrat
authors.initials: M
authors.lastname: Planella
authors.forename: Begoña
authors.initials: B
authors.lastname: González
authors.forename: Xavier
authors.initials: X
authors.lastname: Torras
authors.forename: Jose
authors.initials: J
authors.lastname: Rodríguez
authors.forename: José
authors.initials: J
authors.lastname: Such
authors.forename: Sonia
authors.initials: S
authors.lastname: Pascual
authors.forename: Germán
authors.initials: G
authors.lastname: Soriano
authors.forename: Miguel
authors.initials: M
authors.lastname: Pérez-Mateo
authors.forename: Carlos
authors.initials: C
authors.lastname: Guarner
mesh_terms: D000368:Aged; D000418:Albumins / Q000008:administration & dosage*; D001201:Ascites / Q000175:diagnosis / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000009:adverse effects*; D010952:Plasma Substitutes / Q000008:administration & dosage; D011237:Predictive Value of Tests; D012008:Recurrence; D012965:Sodium Chloride / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D010952:Plasma Substitutes; D012965:Sodium Chloride