Treatment of cirrhotic tense ascites with Dextran-40 versus albumin associated with large volume paracentesis: a randomized controlled trial.
Intravenous albumin infusion prevents complications after large-volume paracentesis (LVP), particularly paracentesis-induced circulatory dysfunction (PCD), and improves patient survival. However, albumin is expensive. We compared a low-molecular weight dextran (Dextran-40) with albumin in treating LVP in cirrhotic patients with tense ascites. Sixty-nine cirrhotic patients were included and 96 LVPs were performed. Any repeat punctures on the same patient were at least three months apart. Patients were randomized to receive either i.v. Dextran-40 infusion (Group I, n = 48) or i.v. albumin infusion after LVP (Group II, n = 48). Clinical, biochemical, and hormonal evaluations were done before and after LVP. Patients were followed up for the detection of any recurrence of ascites or complications. The two groups were similar in age, sex, and etiology of cirrhosis, and in the volumes of ascites recovered. Significant decreases in mean arterial pressure were observed in both groups 24 and 48 h after LVP. Urine volumes increased significantly at 24 h in both groups (p < 0.05), but remained high only in Group I. Plasma renin activity and aldosterone concentrations increased in both groups 48 h after LVP, but they were more marked in Group I. Complications developed in 17 % of patients treated with Dextran-40 and in 23 % treated with albumin (p > 0.05). Ascites recurrence rates and survival were similar in the two groups. In conclusion, Dextran-40 was thus not as efficacious as albumin for preventing PCD.
García-Compean
Diego
D
Service d'Hépato-gastroentérologie, Hôpital Saint-Eloi, Montpellier, France. digarcia@ccr.dsi.uanl.mx
Blanc
Pierre
P
Larrey
Dominique
D
Daures
Jean-Pierre
JP
Hirtz
Jacques
J
Mendoza
Eduardo
E
Maldonado
Héctor
H
Michel
Henri
H
D000368:Aged; D000418:Albumins / Q000008:administration & dosage* / Q000009:adverse effects; D000450:Aldosterone / Q000097:blood; D001201:Ascites / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D001794:Blood Pressure / Q000187:drug effects; D003911:Dextrans / Q000008:administration & dosage* / Q000009:adverse effects; D004231:Diuresis / Q000187:drug effects; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000009:adverse effects*; D010952:Plasma Substitutes / Q000008:administration & dosage* / Q000009:adverse effects; D012008:Recurrence; D012083:Renin / Q000097:blood; D016019:Survival Analysis
D000418:Albumins; D003911:Dextrans; D010952:Plasma Substitutes; D000450:Aldosterone; D012083:Renin