Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites

• Published in: Hepatology (Baltimore, Md.) Vol. 37; no. 5; pp. 1147 - 1153
• Main Authors: Sola-Vera, Javier, Miñana, Josep, Ricart, Elena, Planella, Montserrat, González, Begoña, Torras, Xavier, Rodrı́guez, Jose, Such, José, Pascual, Sonia, Soriano, Germán, Pérez-Mateo, Miguel, Guarner, Carlos
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.05.2003; W.B. Saunders; Wiley
• Subjects: Aged; Albumins - administration & dosage; Ascites - diagnosis; Ascites - therapy; Biological and medical sciences; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hemodynamics - drug effects; Humans; Incidence; Kidney Diseases - epidemiology; Kidney Diseases - etiology; Kidney Diseases - prevention & control; Liver Cirrhosis - diagnosis; Liver Cirrhosis - therapy; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Paracentesis - adverse effects; Plasma Substitutes - administration & dosage; Predictive Value of Tests; Recurrence; Sodium Chloride - administration & dosage; Treatment Outcome; Human; Chemoprophylaxis; Iatrogenic; Effusion; Liver; Albumin; Hepatic disease; Peripheral hemodynamics; Cirrhosis; Randomization; Dysfunction; Abdominal disease; Surgery; Digestive diseases; Complication; Clinical trial; Ascites; Saline solution; Paracentesis
• ISSN: 0270-9139; 1527-3350
• DOI: 10.1053/jhep.2003.50169

Paracentesis-induced circulatory dysfunction (PICD) is a recently described complication that can be prevented with the administration of plasma expanders. The aim of this study was to compare the efficacy of saline versus albumin in the prevention of PICD. Patients were randomized to receive albumin or saline after total paracentesis. Patients readmitted as a consequence of a second episode of tense ascites were treated with total paracentesis and the alternative plasma expander. After randomization, 35 patients received saline and 37 received albumin. Twenty-one patients were readmitted for tense ascites and treated with the alternative expander. Significant increases in plasma renin activity (PRA) were found 24 hours and 6 days after paracentesis when saline was used (baseline, 5.6 ± 5.7; 24 hours, 7.6 ± 6.9; 6 days, 8.5 ± 8.0 ng · mL −1 · hr −1; P < .05 and P < .01 vs. baseline, respectively), whereas no significant changes were observed with albumin. The incidence of PICD was significantly higher in the saline group versus the albumin group (33.3% vs. 11.4%, respectively; P = .03). However, no significant differences were found when less than 6 L of ascitic fluid was evacuated (6.7% vs. 5.6% in the saline and albumin groups, respectively; P = .9). Similar results were observed when analyzing patients who received 2 consecutive paracentesis ( i.e., a significant increase in PRA after saline [ P < .01] without significant variations after albumin). In conclusion, albumin is more effective than saline in the prevention of PICD. Saline is a valid alternative to albumin when less than 6 L of ascitic fluid is evacuated. (H epatology 2003;37:1147-1153.)