title: Low dose albumin for the prevention of renal impairment following large volume paracentesis in cirrhosis.
abstract: OBJECTIVE
  To evaluate the effect of low dose Albumin i.e. 4 grams per litre of ascitic fluid after large volume paracentesis (LVP) for the prevention of paracentesis induced circulatory dysfunction (PICD) related renal impairment in cirrhosis.
  
  
  METHODS
  Case records of all patients with cirrhosis who underwent LVP from January 12(th), 2011 till December 29(th), 2013 were reviewed. Patients were excluded if they had spontaneous bacterial peritonitis, creatinine >1.5 mg/dl, hepatoma or if volume of ascitic fluid removed was <5 litres. Data including age, gender, cause of cirrhosis, CTP score and volume of ascitic fluid drained were noted. In addition serum creatinine and serum sodium at baseline and one week post paracentesis were recorded.
  
  
  RESULTS
  Two hundred and fourteen patients with cirrhosis underwent LVP during the study period. One hundred and thirty nine patients met the inclusion criteria and were analyzed. Patients were divided into two groups based on the amount of albumin given. The amount of albumin given was 25 grams and 50 grams while the volume of ascitic fluid removed were 6.2±1 litres and 10.4±1.5 litres in groups A and B respectively. One hundred and eight patients were in group A while thirty one patients were in group B respectively. Both groups received albumin at a dose of 4 grams per litre of ascitic fluid removed. Mean age in both groups were 53 years. Hepatitis C was the commonest etiology in both the groups, followed by Hepatitis B. More than 70% patients in both the groups were in child class C. Serum creatinine at baseline and one week post LVP was 1.04±0.24 mg/dl and 1.07±0.35 mg/dl in GROUP A while 1.11±0.23 mg/dl and 1.41±0.94 mg/dl in GROUP B. (P value 0.35). Similarly, serum sodium at baseline and one week post LVP was 130 ±5.6 meq/lit and 129.6±5.9 meq/lit in GROUP A while 127.6±5.8 meq/lit and 128±6.2 meq/lit in GROUP B respectively. (P value 0.14).
  
  
  CONCLUSIONS
  This study suggests that 4 grams of albumin per litre of ascitic fluid drained is effective in preventing the PICD related renal impairment following large volume paracentesis in cirrhosis.
authors.affiliation: Waqar Hussain, Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital Karachi. Karachi Pakistan 74800.
authors.forename: Waqar
authors.initials: W
authors.lastname: Hussain
authors.affiliation: Abdullah Bin Khalid, Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital Karachi. Karachi Pakistan 74800.
authors.forename: Abdullah Bin
authors.initials: AB
authors.lastname: Khalid
authors.affiliation: Tayyab Usmani, Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital Karachi. Karachi Pakistan 74800.
authors.forename: Tayyab
authors.initials: T
authors.lastname: Usmani
authors.affiliation: Aiman Ghufran, Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital Karachi. Karachi Pakistan 74800.
authors.forename: Aiman
authors.initials: A
authors.lastname: Ghufran
authors.affiliation: Hasnain Shah, Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital Karachi. Karachi Pakistan 74800.
authors.forename: Hasnain
authors.initials: H
authors.lastname: Shah
keywords: Ascites; Child turcotte pugh score; Large volume paracentesis; Paracentesis induced circulatory dysfunction