Prevention of paracentesis-induced circulatory dysfunction in cirrhosis: Standard vs half albumin doses. A prospective, randomized, unblinded pilot study

Background: Paracentesis-induced circulatory dysfunction is a well-known complication of large volume paracentesis. Albumin infusion (8 g of albumin/L of ascites removed) is effective in preventing it, but high costs and scant availability limit its use. Aim: To compare standard vs half albumin doses. Methods: Seventy cirrhotic patients treated with large volume paracentesis were randomized to receive intravenous albumin as prevention of paracentesis-induced circulatory dysfunction: group 1 (35 patients) received 4 g/L of ascites removed, group 2 (35 patients) received 8 g/L of ascites removed. Results: The incidence of paracentesis-induced circulatory dysfunction (14% vs 20% in group 1 and group 2, respectively: p = ns), hyponatremia (9% vs 6%, p = ns) and renal impairment (0% in both groups) on the 6th day from paracentesis was similar between the two groups. After 6 months of follow-up, rates of survival and of recurrence of ascites requiring large volume paracentesis were not different between the two groups. Conclusions: This unblinded, randomized, pilot study suggests that treatment with half doses of albumin is effective in the prevention of paracentesis-induced circulatory dysfunction and its related clinical complications in cirrhotic patients with tense ascites treated by large volume paracentesis. If confirmed, these results could support a significant costs reduction in the management of ascites in cirrhotic patients. (C) 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.