title: Albumin May Prevent the Morbidity of Paracentesis-Induced Circulatory Dysfunction in Cirrhosis and Refractory Ascites: A Pilot Study.
abstract: Large-volume total paracentesis may result in paracentesis-induced circulatory dysfunction, which is associated with poor outcomes.
  
  
  
  To explore the short- and long-term effects of paracentesis-induced circulatory dysfunction on systemic hemodynamics, renal function and other cirrhosis-related complications in patients with refractory ascites, following subtotal large-volume paracentesis.
  
  
  
  Patients with cirrhosis and refractory ascites without renal dysfunction had systemic hemodynamics, renal function, and neurohormones (plasma active renin, aldosterone, norepinephrine and angiotensin II) measured pre- and 6 days post-paracentesis. Paracentesis was limited to ≤8 L with 6-8 g of albumin per liter ascites drained. Patients were followed up until transjugular intrahepatic portosystemic shunt insertion, liver transplantation, or death. Paracentesis-induced circulatory dysfunction was defined as >50 % increase in plasma active renin 6 days post-paracentesis.
  
  
  
  Fifty-seven patients (mean age 59.0 ± 9.4 years) had mean 6.8 ± 1.8 L of ascites removed with 9 ± 3 g of albumin given/L of ascites drained. Patients were followed up for 715 ± 104 days. Twenty-three patients (40.4 %) developed paracentesis-induced circulatory dysfunction with unchanged serum creatinine on day six, despite worsening of hemodynamics (mean arterial pressure 90 ± 10 mmHg at baseline vs. 84 ± 8 mmHg on day six, p < 0.05). Similar hemodynamic changes were observed among patients without paracentesis-induced circulatory dysfunction. There was no significant difference in the long-term renal function or cirrhosis-related complications between the groups.
  
  
  
  The occurrence of paracentesis-induced circulatory dysfunction, as defined by plasma active renin, may not have a significant short- and long-term impact on renal function or cirrhosis-related complications in patients with refractory ascites who undergo subtotal paracentesis with albumin infusion.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Toronto General Hospital, 9EN/222, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.|Department of Gastroenterology and Hepatology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
authors.forename: Hiang Keat
authors.initials: HK
authors.lastname: Tan
authors.affiliation: Division of Gastroenterology, Department of Medicine, Toronto General Hospital, 9EN/222, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.|Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, 1919 Riverside Drive, Ottawa, ON, K1H 8L6, Canada.
authors.forename: Paul Damien
authors.initials: PD
authors.lastname: James
authors.affiliation: Division of Gastroenterology, Department of Medicine, Toronto General Hospital, 9EN/222, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. florence.wong@utoronto.ca.
authors.forename: Florence
authors.initials: F
authors.lastname: Wong
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000418:Albumins / Q000627:therapeutic use*; D000450:Aldosterone / Q000097:blood; D000804:Angiotensin II / Q000097:blood; D001201:Ascites / Q000209:etiology / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009638:Norepinephrine / Q000097:blood; D016017:Odds Ratio; D019152:Paracentesis / Q000009:adverse effects* / Q000379:methods; D010865:Pilot Projects; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012083:Renin / Q000097:blood; D012307:Risk Factors
chemical_list: D000418:Albumins; D000804:Angiotensin II; D000450:Aldosterone; D012083:Renin; D009638:Norepinephrine
keywords: Ascites; Cirrhosis; Large-volume paracentesis; Paracentesis-induced circulatory dysfunction; Renal failure