Midodrine versus albumin in the prevention of paracentesis-induced circulatory dysfunction in cirrhotics: a randomized pilot study.
OBJECTIVE
Intravenous albumin has been used to prevent paracentesis-induced circulatory dysfunction (PICD) in cirrhotics; however, its use is costly and controversial. Splanchnic arterial vasodilatation is primarily responsible for PICD. There are no reports of use of midodrine in the prevention of PICD. In this pilot study, we evaluated midodrine and albumin in the prevention of PICD.


METHODS
Forty patients with cirrhosis underwent therapeutic paracentesis with midodrine or albumin in a randomized controlled trial at a tertiary center. Effective arterial blood volume was assessed by plasma renin activity.


RESULTS
Plasma renin activity at baseline and at 6 days after paracentesis did not differ in the two groups (43.18 +/- 10.73 to 45.90 +/- 8.59 ng/mL/h, P= 0.273 in the albumin group and 44.44 +/- 8.44 to 41.39 +/- 10.21 ng/mL/h, P= 0.115 in the midodrine group). Two patients had an increase in plasma renin activity of more than 50% from baseline in the albumin group, and none in the midodrine group. A significant increase in 24-h urine volume and urine sodium excretion was noted in the midodrine group. Midodrine therapy was cheaper than albumin therapy.


CONCLUSIONS
The study suggests that midodrine may be as effective as albumin in preventing PICD in cirrhotics, but at a fraction of the cost, and can be administered orally. Midodrine also resulted in an increase in 24-h urine volume and sodium excretion.
Department of Hepatology, Postgraduate Insitiute of Medical Education and Research, Chandigarh, India.
Virendra
V
Singh
Prashant C
PC
Dheerendra
Baljinder
B
Singh
Chander K
CK
Nain
Divya
D
Chawla
Navneet
N
Sharma
Ashish
A
Bhalla
Sushil K
SK
Mahi
D000328:Adult; D001201:Ascites / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D020896:Hypovolemia / Q000209:etiology / Q000517:prevention & control*; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000627:therapeutic use*; D019152:Paracentesis / Q000009:adverse effects*; D010865:Pilot Projects; D012709:Serum Albumin / Q000627:therapeutic use; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D012709:Serum Albumin; D014662:Vasoconstrictor Agents; D008879:Midodrine