Plasma volume expansion by albumin in cirrhosis. Relation to blood volume distribution, arterial compliance and severity of disease

Background/Aims: The aim of the study was to investigate the effect of a standard albumin load on blood volume distribution, arterial compliance, and the renin-angiotensin-aldosterone system in patients with different degrees of cirrhosis. Methods: 31 patients with cirrhosis (Child classes A/B/C = 8/14/9) received an intravenous infusion of 40 g human serum albumin during a haemodynamic investigation. Results: Whereas plasma- and blood volume increased by 23 and 15%, respectively (P < 0.001), a significant increase in central blood volume was found only in class A patients (+8 %, P < 0.05), but not in class B or class C patients (+2.7%, not significant (n.s.)). In contrast, arterial compliance only increased significantly in class C patients (+18%, P < 0.05), but not in class A or class B patients (+6%, n.s.). Plasma renin activity (PRA) decreased significantly in class C patients (-31%, P < 0.05). When all patients were compared, the change in arterial compliance was inversely correlated to the change in PRA (r = -0.50, P < 0.01). Conclusions: Although infusion of albumin does not expand the central blood volume in patients with advanced cirrhosis, the results indicate a significant improvement in the low effective arterial blood volume of such patients, which may be important in the prevention of circulatory dysfunction. (C) 2003 European Association ford the Study of the Liver. Published by Elsevier Science B.V. All rights reserved.