Prevention of paracentesis-induced circulatory dysfunction: midodrine vs albumin. A randomized pilot study.
OBJECTIVE
Large-volume paracentesis in patients with cirrhosis and ascites induces arterial vasodilatation and decreases effective arterial blood volume, termed paracentesis-induced circulatory dysfunction (PICD), which can be prevented by costly intravenous albumin. Vasoconstrictors, e.g. terlipressin, may also prevent PICD. The aim was to compare the less expensive vasoconstrictor midodrine, an alpha-adrenoceptor agonist, with albumin in preventing PICD.


METHODS
Twenty-four patients with cirrhosis and ascites were randomly assigned to be treated with either midodrine (n=11) (12.5 mg three times per day; over 2 days) or albumin (n=13) (8 g/L of removed ascites) after large-volume paracentesis. Effective arterial blood volume was assessed indirectly by measuring plasma renin and aldosterone concentration on days 0 and 6 after paracentesis; renal function and haemodynamic changes were also measured. PICD was defined as an increase in plasma renin concentration on day 6 by more than 50% of the baseline value.


RESULTS
PICD developed in six patients of the midodrine group (60%) and in only four patients (31%) of the albumin group. Six days after paracentesis, the aldosterone concentration increased significantly in the midodrine group, but not in the albumin group.


CONCLUSIONS
This pilot study suggests that midodrine is not as effective as albumin in preventing circulatory dysfunction after large-volume paracentesis in patients with cirrhosis and ascites.
Appenrodt
Beate
B
Department of Internal Medicine I, University of Bonn, Bonn, Germany. beate.appenrodt@ukb.uni-bonn.de
Wolf
Andrea
A
Grünhage
Frank
F
Trebicka
Jonel
J
Schepke
Michael
M
Rabe
Christian
C
Lammert
Frank
F
Sauerbruch
Tilman
T
Heller
J
J
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000418:Albumins / Q000008:administration & dosage / Q000627:therapeutic use*; D000450:Aldosterone / Q000097:blood; D001201:Ascites / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D020896:Hypovolemia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000627:therapeutic use*; D019152:Paracentesis / Q000009:adverse effects*; D010865:Pilot Projects; D012083:Renin / Q000097:blood; D016896:Treatment Outcome
D000316:Adrenergic alpha-Agonists; D000418:Albumins; D000450:Aldosterone; D008879:Midodrine; D012083:Renin