Randomized comparative study of hemaccel vs. albumin infusion after total paracentesis in cirrhotic patients with refractory ascites

Salerno, Francesco; Badalamenti, Salvatore; Lorenzano, Elettra; Moser, P.; Incerti, Pierluigi

doi:10.1002/hep.1840130416

Cited by 118 publications

(50 citation statements)

References 17 publications

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“…34 There have been 5 randomized controlled trials comparing volume expansion with albumin with other forms of plasma expanders, including dextrans, collagen-based colloids, and hydroxyethyl starch. [35][36][37][38][39] All studies have shown that synthetic plasma expanders are as effective as albumin at preventing the clinical complications of paracentesis, namely hyponatremia or renal impairment. However, Gines et al showed that PPH, as defined by an increase in plasma renin activity or aldosterone concentrations, was prevented more effectively by albumin than synthetic plasma expanders.…”

Section: Paracentesismentioning

confidence: 99%

The Management of Ascites in Cirrhosis: Report on the Consensus Conference of the International Ascites Club

et al. 2003

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Ascites is a common complication of cirrhosis, and heralds a new phase of hepatic decompensation in the progression of the cirrhotic process. The development of ascites carries a significant worsening of the prognosis. It is important to diagnose noncirrhotic causes of ascites such as malignancy, tuberculosis, and pancreatic ascites since these occur with increased frequency in patients with liver disease. The International Ascites Club, representing the spectrum of clinical practice from North America to Europe, have developed guidelines by consensus in the management of cirrhotic ascites from the early ascitic stage to the stage of refractory ascites. Mild to moderate ascites should be managed by modest salt restriction and diuretic therapy with spironolactone or an equivalent in the first instance. Diuretics should be added in a stepwise fashion while maintaining sodium restriction. Gross ascites should be treated with therapeutic paracentesis followed by colloid volume expansion, and diuretic therapy. Refractory ascites is managed by repeated large volume paracentesis or insertion of a transjugular intrahepatic portosystemic stent shunt (TIPS). Successful placement of TIPS results in improved renal function, sodium excretion, and general well-being of the patient but without proven survival benefits. Clinicians caring for these patients should be aware of the potential complications of each treatment modality and be prepared to discontinue diuretics or not proceed with TIPS placement should complications or contraindications develop. Liver transplantation should be considered for all ascitic patients, and this should preferably be performed prior to the development of renal dysfunction to prevent further compromise of their prognosis. (HEPATOLOGY 2003;38:258-266.)

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Section: Paracentesismentioning

confidence: 99%

The Management of Ascites in Cirrhosis: Report on the Consensus Conference of the International Ascites Club

et al. 2003

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“…[52][53][54] Part of the controversy regarding post-paracentesis plasma expanders relates to study design. More studies are needed, in particular, studies that target survival as the specific study endpoint in patients with truly diuretic-resistant ascites.…”

Section: Introductionmentioning

confidence: 99%

Management of adult patients with ascites caused by cirrhosis†

Runyon¹

1998

Hepatology

302

131

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Ascites is the most common of the major complications of cirrhosis. The development of ascites is an important landmark in the natural history of cirrhosis and has been proposed as an indication for liver transplantation. The initial evaluation of a patient with ascites should include a history, physical evaluation, and abdominal paracentesis with ascitic fluid analysis. Treatment should consist of abstinence from alcohol, sodium restricted diet, and diuretics. This regimen is effective in Ϸ90% of patients. The treatment options for the diuretic-resistant patients include serial therapeutic paracenteses, liver transplantation, and peritoneovenous shunting. (HEPATOLOGY 1998;27;264-272.) PREAMBLE These guidelines provide a data-supported approach to the care of patients with ascites. They are based on the following: 1) a formal review and analysis of the published world literature (1,045 papers) on ascites (Medline Search from 1966-1996, search terms included ascites, diet therapy, drug therapy, radiotherapy, surgery, and therapy); 2) the American College of Physician' s Manual for Assessing Health Practices and Designing Practice Guidelines 1 ; and 3) several published and draft guidelines, including the American Association for the Study of Liver Diseases' Policy Statement on Development and Use of Practice Guidelines and American Gastroenterological Association' s Policy Statement on Guidelines 2 ; and 4) 15 years of experience on the part of the author in the clinical and laboratory investigations of and care for patients with this problem.These guidelines, intended for use by physicians, suggest preferable approaches to the diagnostic, therapeutic, and preventative aspects of care. These guidelines are intended to be flexible, in contrast with ''standards of care,'' which are inflexible policies to be followed in almost every case. 1 Furthermore, these guidelines were developed for the care of adult patients with clinically detectable ascites. Although the general approach may be applicable to children, the pediatric data base is much smaller and there may be unanticipated differences between adults and children. Patients with ascites that is detected by imaging modalities alone, but not yet clinically evident, are not included because of the lack of published information regarding the natural history of this entity.Specific recommendations are based on relevant published information. In an attempt to standardize recommendations, the Practice Guidelines Committee of the American Association for the Study of Liver Diseases modified the categories of the Infectious Diseases Society of America' s Quality Standards. 3 These categories are reported with each recommendation, using the letters A through E to determine the strength of recommendation and roman numerals I through III to determine quality of evidence upon which recommendations are based, as follows: A, survival benefit; B, improved diagnosis; C, improvement in quality of life; D, relevant pathophysiologic parameters improved; E, impacts cost of heal...

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“…Nonetheless, studies have not shown that this practice has benefit over infusion of synthetic colloids. 24 When spontanous bacterial peritonitis develop in patients with cirr- hosis, renal function frequently becomes impaired. This impairment is probably related to a reduction in effective arterial blood volume and is associated with a high mortality.…”

Section: Discussionmentioning

confidence: 99%

Albumin Infusion is not Beneficial in Hypoalbuminemic End-Stage Cancer Patients: A Matched-Pair Analysis

Büyükçelik¹

2012

UHOD

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In this retrospective study, it was aimed whether albumin infusion is benefical or not in terminally ill hospitalized hypoalbuminemic cancer patients. Between March 2000 and 31 March 2003, the medical records of 27 terminally ill hypoalbuminemic cancer patients who had albumin infusion(Albumin receiving group-ARG), were retrospectively analysed. This grup was matched (1:1) with 27 terminally ill cancer patients who had no albumin infusion (Albumin not receiving group-ANRG), according to age, sex, ECOG PS, diagnosis and the number of metastatic sites. ARG was compared with ANRG, in regard to the changes of pulse rate, blood pressure, in the levels of serum BUN, creatinin, sodium, total protein, and albumin before albumin infusion and 48 hours after albumin infusion, and documented and/or clinical infections after albumin infusion, hospitalization duration, the rate of exitus in hospital and overall survival. There was no difference in patient characteristics between two groups. Likewise, the groups were not different from each other in terms of the changes of puls rate, blood pressure, in the levels of serum BUN, creatinin, sodium, and documented and/or clinical infections after albumin infusion (p> 0.05). There was a significant increase in the levels of serum total protein and albumin in ARG (p< 0.05). The rate of exitus in hospital is not different between two groups. The median duration of hospitalization was longer in ANRG (p= 0.022). The overall survival was significantly better in ANRG (p= 0.018). Albumin infusion is not benefical in terminally ill hypoalbuminemic cancer patients. Furthermore, it was found that the survival was significantly worse in patients receiving albumin.

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Randomized comparative study of hemaccel vs. albumin infusion after total paracentesis in cirrhotic patients with refractory ascites

Cited by 118 publications

References 17 publications

The Management of Ascites in Cirrhosis: Report on the Consensus Conference of the International Ascites Club

The Management of Ascites in Cirrhosis: Report on the Consensus Conference of the International Ascites Club

Management of adult patients with ascites caused by cirrhosis†

Albumin Infusion is not Beneficial in Hypoalbuminemic End-Stage Cancer Patients: A Matched-Pair Analysis

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