The impact of paracentesis flow rate in patients with liver cirrhosis on the development of paracentesis induced circulatory dysfunction

Elsabaawy, Maha; Abdelhamid, Shimaa Rashad; Alsebaey, Ayman; Abdelsamee, Eman; Obada, Manar; Salman, Tary; Rewisha, Eman

doi:10.3350/cmh.2015.21.4.365

Cited by 15 publications

(14 citation statements)

References 36 publications

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“…First, compensatory reactions to portal hypertension, including excessive splanchnic vasodilatation and abnormal acceleration of the vasoconstrictor system, reduce effective arterial volume and renal blood flow, ultimately inducing renal impairment . In addition, diuretics overdose, frequent exposure to contrast media used for hepatocellular carcinoma surveillance, and repeated large volume paracentesis for management of refractory ascites could also induce hemodynamic instability and nephrotoxicity . AKIs in cirrhotic patients have traditionally been classified into three types: prerenal azotemia (PRA), hepatorenal syndrome (HRS), and acute tubular necrosis (ATN).…”

Section: Introductionmentioning

confidence: 99%

Assessment and prediction of acute kidney injury in patients with decompensated cirrhosis with serum cystatin C and urine N‐acetyl‐β‐D‐glucosaminidase

Kim

Lee

Seo

et al. 2018

J of Gastro and Hepatol

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Section: Introductionmentioning

confidence: 99%

Assessment and prediction of acute kidney injury in patients with decompensated cirrhosis with serum cystatin C and urine N‐acetyl‐β‐D‐glucosaminidase

Kim

Lee

Seo

et al. 2018

J of Gastro and Hepatol

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“…PICD development is unrelated to the paracentesis flow rate [12]. Sersté et al [13] accused Beta blockers in the development of PICD in a small number study (n = 10).…”

Section: Discussionmentioning

confidence: 99%

High efficacy of low-dose albumin infusion in the prevention of paracentesis-induced circulatory dysfunction

Alsebaey

Rewisha

Waked

2020

Egypt Liver Journal

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Background: Large-volume paracentesis (LVP) is a main pillar in treating patients with tense ascites. Without plasma expanders use, paracentesis-induced circulatory dysfunction (PICD) is a common complication with decreased survival. The aim was to compare low-dose albumin (2 g/L ascitic fluid removed n = 85) with standarddose albumin (6 g/L ascitic fluid removed, n = 25) for prevention of PICD. Liver function tests, urea, creatinine, CBC, and abdominal ultrasonography were done. Plasma renin activity (PRA) was measured at baseline and on the 6th day post-LVP. The delta change (Δ) = day 6 variable minus baseline variable value. PICD was defined as increase in PRA of > 50% of the baseline value. Results: Patients in low-dose albumin group were mainly Child B compared with Child C (85.9% vs. 52%; p = 0.001), underwent less paracentesis volume (9.78 ± 3.56 vs. 12.52 ± 3.6 L; p = 0.001), but had higher baseline PRA (859.62 ± 1151.34 vs. 165.93 ± 95.34 pg/mL; p = 0.001). In both groups, the PRA increased at day 6 compared with the baseline (1141.57 ± 1433.01 vs. 859.62 ± 1151.34 pg/mL; p = 0.01) and (192.21 ± 80.99 vs. 165.93 ± 95.34 pg/ mL; p = 0.01) respectively. Both groups were comparable for Δ PRA (281.95 ± 851.4 vs. 26.28 ± 30.2 pg/mL; p = 0.102) and PRA percent increase (10.97 ± 30.77 vs. 12.57 ± 14.87; p = 0.844). They had comparable PICD incidence (24.7% vs. 12%; p = 0.27). Females were more liable for PICD occurrence than males (OR 2.91, 95% CI 1.125-7.547, p = 0.028) and so Child B patients than Child C (OR 8.4, 95% CI 1.072-65.767, p = 0.043). Conclusion: Low-dose albumin infusion is comparable to the standard-dose albumin for the prevention of PICD.

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“…Several different therapeutic approaches have been tested in cirrhotic patients with RA; including, surgical portocaval anastomosis [11], paracentesis with i.v. albumin infusion [12], transjugular intrahepatic portacaval shunt [12] and diuretics [13]. Cirrhotic patients with RA are characterized by renal sodium and water retention with edema formation.…”

Section: Discussionmentioning

confidence: 99%

High Dose Oral Furosemide with Salt Ingestion in the Treatment of Refractory Ascites of Liver Cirrhosis

Yakar¹,

Demır²,

Doğan³

et al. 2016

CIM

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Purpose: We aimed to evaluate and compare the efficacy and safety of high-dose furosemide+salt orally by comparing HSS+ furosemide (i.v.) and repeated paracentesis in patients with RA.Methods: This was a prospective study of 78 cirrhotic patients with RA, randomized into three groups: Group A (n= 25) i.v. furosemide (200-300 mg bid) and 3% hypotonic saline solution (HSS) (once or twice a day); Group B (n= 26) oral furosemide tablets (360-520 mg bid) and salt (2.5 g bid); and, Group C (n= 27) repeated large-volume-paracentesis (RLVP) with albumin infusion. Patients without hyperkalemia were administrated 100 mg of spironolactone/day. During the follow-up; INR, creatinine, and total bilirubin levels were measured to determine the change in MELD (model of end stage liver disease) score.Results: Hepatic encephalopathy (HE), severe episodes of spontaneous bacterial peritonitis (SBP) and pleural effusions (PE) occurred more frequently in Group C. Improvement in Child-Pugh and MELD score was better in Group A and B than Group C. In Group B, improvements were seen in the Child-Pugh and MELD score, reduction in body weight, duration and number of hospitalization. In Groups A and B, remarkable increases in diuresis were observed (706±116 to 2425±633 mL and 691±111 to 2405±772 mL) and serum sodium levels also improved. HE and SBP were occurred more often in group C (p<0.002). Hospitalization decreased significantly in Group B (p<0.001). There was no significant difference in survival among groups. Conclusion:High dose oral furosemide with salt ingestion may be an alternative, effective, safe and well-tolerated method of therapy for RA.SUPPLEMENT

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The impact of paracentesis flow rate in patients with liver cirrhosis on the development of paracentesis induced circulatory dysfunction

Cited by 15 publications

References 36 publications

Assessment and prediction of acute kidney injury in patients with decompensated cirrhosis with serum cystatin C and urine N‐acetyl‐β‐D‐glucosaminidase

Assessment and prediction of acute kidney injury in patients with decompensated cirrhosis with serum cystatin C and urine N‐acetyl‐β‐D‐glucosaminidase

High efficacy of low-dose albumin infusion in the prevention of paracentesis-induced circulatory dysfunction

High Dose Oral Furosemide with Salt Ingestion in the Treatment of Refractory Ascites of Liver Cirrhosis

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