title: Comparison of midodrine and albumin in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients: a randomized pilot study.
abstract: OBJECTIVE
  In this pilot study, we compared midodrine and albumin in the prevention of paracentesis-induced circulatory dysfunction (PICD).
  
  
  BACKGROUND
  PICD with pronounced arterial vasodilatation in cirrhotics with tense ascites can be prevented by the infusion of albumin, which is an expensive treatment modality. Various vasoconstrictors have also been used to prevent PICD, but there are few studies about the usage of midodrine.
  
  
  METHODS
  Fifty patients with cirrhosis and tense refractory ascites were randomly assigned to be treated with either midodrine (n=25) (12.5 mg 3 times/d; over 3 d) or albumin (n=25) (8 g/L of removed ascites) after a large-volume paracentesis. Effective arterial blood volume was assessed indirectly by measuring serum creatinine, serum sodium, plasma renin activity, and aldosterone concentration before and 6 days after paracentesis.
  
  
  RESULTS
  Midodrine therapy was cheaper compared with albumin therapy, but serum creatinine, serum sodium, plasma renin activity, and plasma aldosterone concentration values after treatment [0.99±0.19 to 3.02±2.58 mg/dL (P=0.001), 132.36±3.2 to 130.2±4.1 mEq/L (P<0.001), 3.03±0.33 to 4.2±0.76 ng/mL/h (P<0.001), and 166.72±64.26 to 298.64±130 pg/mL (P<0.001), respectively] significantly differed in the midodrine group from that in the albumin group [1.10±0.22 to 1.11±0.161 mg/dL (P=0.885), 132.2±3.524 to 131.88±3.09 mEq/L (P=0.246), 4±0.91 to 4.11±0.74 ng/mL/h (P=0.440), and 204.88±115.9 to 177.08±100.5 pg/mL (P<0.001), respectively]. Seven patients, among whom 6 were hepatocellular carcinoma (HCC) positive, in the midodrine group of our study died as a consequence of liver failure complicated by acute renal failure, followed by hepatic encephalopathy. Whereas in the albumin group, even among the 7 patients with HCC, no patient died or developed hepatorenal syndrome or developed hepatic encephalopathy.
  
  
  CONCLUSIONS
  This pilot study suggests that midodrine is not as effective as intravenous albumin in preventing circulatory dysfunction after large-volume paracentesis in patients with cirrhosis and tense ascites, especially with HCC-positive patients.
authors.affiliation: Departments of *Tropical Medicine, Gastroenterology, and Hepatology †Clinical Pathology and Chemistry Medical Research Center, Ain Shams University, Abbasiya, Cairo, Egypt.
authors.forename: Hassan
authors.initials: H
authors.lastname: Hamdy
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: ElBaz
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hassan
authors.forename: Omayma
authors.initials: O
authors.lastname: Hassanin
mesh_terms: D000418:Albumins / Q000627:therapeutic use*; D000450:Aldosterone / Q000097:blood; D001201:Ascites / Q000209:etiology / Q000628:therapy*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D020896:Hypovolemia / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000627:therapeutic use*; D019152:Paracentesis / Q000009:adverse effects*; D010865:Pilot Projects; D012083:Renin / Q000097:blood; D012964:Sodium / Q000097:blood; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D000418:Albumins; D014662:Vasoconstrictor Agents; D000450:Aldosterone; D008879:Midodrine; D012964:Sodium; D003404:Creatinine; D012083:Renin