Effects of alfapump™ system on kidney and circulatory function in patients with cirrhosis and refractory ascites.
The alfapump system has been proposed as a new treatment for the management of refractory ascites. The system removes ascites from the peritoneal cavity to urinary bladder, producing a continuous low-volume paracentesis. The aim of the study is to investigate the effects of treatment with the alfapump™ system on kidney and circulatory function in patients with cirrhosis and refractory ascites. This was a prospective study including 10 patients with cirrhosis and refractory ascites. Primary outcomes were changes in glomerular filtration rate (GFR), as assessed by isotopic techniques, and changes in circulatory function assessed by arterial pressure, cardiac output, and activity of vasoconstrictor systems. Secondary outcomes were the need for large-volume paracentesis and adverse events. Follow-up was 1 year. GFR decreased significantly from 67 mL/minute/1.73 m2(41-90 mL/minute/1.73 m2) at baseline to 45 mL/minute/1.73 m2(36-74 mL/minute/1.73 m2) at month 6 (P = 0.04). Mean arterial pressure and cardiac output did not change significantly; however, there was a marked increase in plasma renin activity and norepinephrine concentration (median percent increase with respect to baseline +191% and 59%, respectively). There were 68 episodes of complications of cirrhosis in 8 patients during follow-up, the most frequent being acute kidney injury. In conclusion, treatment with alfapump™ system was associated with marked activation of endogenous vasoconstrictor systems and impairment of kidney function. The chronological relationship observed between kidney impairment and vasoconstrictor systems activation after device insertion suggests a cause-effect relationship, raising the possibility that treatment with alfapump impairs effective arterial blood volume mimicking a postparacentesis circulatory dysfunction syndrome. In this context, the potential role of albumin in counteracting these effects should be investigated in future studies. Liver Transplantation 23 583-593 2017 AASLD.
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Elsa
E
Solà
HBP Surgery and Liver Transplantation Unit, University of Barcelona, Barcelona, Spain.
Santiago
S
Sanchez-Cabús
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Ezequiel
E
Rodriguez
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Chiara
C
Elia
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Raquel
R
Cela
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Rebeca
R
Moreira
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Elisa
E
Pose
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.|Hospital Parc Taulí, Sabadell, Spain.
Jordi
J
Sánchez-Delgado
Hospital del Mar, Barcelona, Spain.
Nuria
N
Cañete
Biochemistry and Molecular Genetics Department, Hospital Clínic, University of Barcelona, Barcelona, Spain.
Manuel
M
Morales-Ruiz
Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain.
Francisco
F
Campos
Anesthesiology Department, Hospital Clínic, Barcelona, Spain.
Jaume
J
Balust
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Mónica
M
Guevara
HBP Surgery and Liver Transplantation Unit, University of Barcelona, Barcelona, Spain.
Juan Carlos
JC
García-Valdecasas
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Pere
P
Ginès
D000368:Aged; D001201:Ascites / Q000209:etiology / Q000628:therapy*; D001810:Blood Volume; D004322:Drainage / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D000075082:Proof of Concept Study; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D014661:Vasoconstriction