Beneficial effects of intravenous albumin infusion on the hemodynamic and humoral changes after total paracentesis

Abstract

The study investigated the hemodynamic and neurohumoral effects of albumin infusion after total paracentesis in 18 patients with cirrhosis and tense ascites. Measurements of systemic and splanchnic hemodynamics, and vasoactive neurohumoral systems were performed before and immediately after total paracentesis. The patients were then randomized to receive albumin or not, and hemodynamic and humoral measurements were repeated at 24 hours. Hemodynamic and humoral changes just after paracentesis were similar in patients later randomized to receive albumin infusion or not. Twenty-four hours after total paracentesis, patients not receiving albumin had significant reductions in cardiac index (-13%; P = .005), femoral blood flow (-17% P = .004), and pulmonary capillary pressure (-16%; P = .02), which were accompanied by significant increases in plasma renin activity (PRA) and plasma aldosterone (PA) and by significant decreases in atrial natriuretic factor (ANJ?) and plasma sodium. By contrast, there were no significant changes in patients receiving albumin, except for an increase in ANF and a further decrease in PA. In both groups, hepatic venous pressure gradient (HVPG) and azygos blood flow decreased just after paracentesis returning to baseline at 24 hours. This study shows that albumin infusion prevents the impairment in systemic hemodynamics, vasoactive neurohumoral systems, and plasma sodium after a large-volume paracentesis, without detrimental effects on portal pressure and portocollateral blood flow. (HEPATOLOGY 1995;22: 753-758.)

Effect of intravenous albumin on systemic and hepatic hemodynamics and vasoactive neurohormonal systems in patients with cirrhosis and spontaneous bacterial peritonitis

“…This finding is in concordance with previous studies evaluating splanchnic hemodynamics after albumin administration in cirrhosis [18,19] and is also consistent with the study of Ruiz del Arbol et al in the sense that portal pressure only increases in patients with SBP in the setting of an impairment in circulatory function [3].…”

A Randomized Unblinded Pilot Study Comparing Albumin Versus Hydroxyethyl Starch in Spontaneous Bacterial Peritonitis * #

“…Samples were placed on ice, centrifuged at 4°C, and stored at Ϫ30°C until assayed. Plasma renin activity and atrial atriuretic factor were measured by RIA (Clinical Assay, Baxter, Cambridge, MA, and EuroDiagnostica, Malmö, Sweden) 26,27 and IL-6 and TNF-␣ by ELISA (Medgenix Diagnostics SA, Fleurus, Belgium). 2 Normal values in our laboratory are: plasma renin activity, 1.4 Ϯ 0.9 ng⅐mL/h; atrial natriuretic factor, 19 Ϯ 5 fmol/mL; IL-6, Ͻ 5 pg/mL, TNF-␣, Ͻ 20 pg/mL.…”

Human serum albumin: From bench to bedside

“…HSA may be effective in preventing the hemodynamic derangements associated with total paracentesis or serial large volume paracentesis (Salerno et al, 1987;Luca et al, 1995;Ruiz-del-Arbol et al, 1997;Mendez et al, 2005a) to decrease frequency of renal impairment and mortality in patients with spontaneous bacterial peritonitis (Sort et al, 1999;Mendez et al, 2005a), and, in association with splanchnic vasopressors, in caring for patients with the hepatorenal syndrome (Guevara et al, 1998;Angeli et al, 1999;Duvoux et al, 2002;Reith and Werdan, 2004;Mendez et al, 2005a;Jacob et al, 2008;Vincent, 2009;Polli and Gattinoni, 2010).…”