Prevention of paracentesis-induced circulatory dysfunction: Midodrine vs albumin. A randomized pilot study

Abstract

Background/Aims: Large-volume paracentesis in patients with cirrhosis and ascites induces arterial vasodilatation and decreases effective arterial blood volume, termed paracentesis-induced circulatory dysfunction (PICD), which can be prevented by costly intravenous albumin. Vasoconstrictors, e.g. terlipressin, may also prevent PICD. The aim was to compare the less expensive vasoconstrictor midodrine, an α-adrenoceptor agonist, with albumin in preventing PICD. Methods: Twenty-four patients with cirrhosis and ascites were randomly assigned to be treated with either midodrine (n = 11) (12.5mg three times per day; over 2 days) or albumin (n = 13) (8 g/L of removed ascites) after large-volume paracentesis. Effective arterial blood volume was assessed indirectly by measuring plasma renin and aldosterone concentration on days 0 and 6 after paracentesis; renal function and haemodynamic changes were also measured. PICD was defined as an increase in plasma renin concentration on day 6 by more than 50% of the baseline value. Results: PICD developed in six patients of the midodrine group (60%) and in only four patients (31%) of the albumin group. Six days after paracentesis, the aldosterone concentration increased significantly in the midodrine group, but not in the albumin group. Conclusions: This pilot study suggests that midodrine is not as effective as albumin in preventing circulatory dysfunction after large-volume paracentesis in patients with cirrhosis and ascites. © Journal compilation © 2008 Blackwell Munksgaard.