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

BackgroundParacentesis-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.AimTo compare standard vs half albumin doses.MethodsSeventy 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.ResultsThe 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.ConclusionsThis 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.

► PICD is a frequent and harmful complication of large volume paracentesis in cirrhosis.
► The efficacy of albumin (8 g/L of ascites removed) in preventing it is demonstrated.
► Albumin has high costs and limited availability.
► Half doses (4 g/L) were effective in preventing PICD and its clinical complications.
► Achievement: significant costs reduction in the management of ascites in cirrhosis.