Pathophysiology and Prevention of Paracentesis-induced Circulatory Dysfunction: A Concise Review

Anand V Kulkarni, Pramod Kumar, Mithun Sharma, T R Sowmya, Rupjyoti Talukdar, Padaki Nagaraj Rao, D Nageshwar Reddy, Anand V Kulkarni, Pramod Kumar, Mithun Sharma, T R Sowmya, Rupjyoti Talukdar, Padaki Nagaraj Rao, D Nageshwar Reddy

Abstract

Annually, 10% of cirrhotic patients with ascites develop refractory ascites for which large-volume paracentesis (LVP) is a frequently used therapeutic procedure. LVP, although a safe method, is associated with circulatory dysfunction in a significant percentage of patients, which is termed paracentesis-induced circulatory dysfunction (PICD). PICD results in faster reaccumulation of ascites, hyponatremia, renal impairment, and shorter survival. PICD is diagnosed through laboratory results, with increases of >50% of baseline plasma renin activity to a value ≥4 ng/mL/h on the fifth to sixth day after paracentesis. In this review, we discuss the pathophysiology and prevention of PICD.

Keywords: Cirrhosis; Large-volume paracentesis; Plasma renin activity; Portal hypertension; Refractory ascites.

Conflict of interest statement

The authors have no conflict of interests related to this publication.

© 2020 Authors.

Figures

Fig. 1.. Mechanism of PICD and complications.
Fig. 1.. Mechanism of PICD and complications.

References

    1. Ginés P, Quintero E, Arroyo V, Terés J, Bruguera M, Rimola A, et al. Compensated cirrhosis: natural history and prognostic factors. Hepatology. 1987;7:122–128. doi: 10.1002/hep.1840070124.
    1. Bernardi M, Laffi G, Salvagnini M, Azzena G, Bonato S, Marra F, et al. Efficacy and safety of the stepped care medical treatment of ascites in liver cirrhosis: a randomized controlled clinical trial comparing two diets with different sodium content. Liver. 1993;13:156–162. doi: 10.1111/j.1600-0676.1993.tb00624.x.
    1. Angeli P, Dalla Pria M, De Bei E, Albino G, Caregaro L, Merkel C, et al. Randomized clinical study of the efficacy of amiloride and potassium canrenoate in nonazotemic cirrhotic patients with ascites. Hepatology. 1994;19:72–79. doi: 10.1002/hep.1840190113.
    1. Bureau C, Thabut D, Oberti F, Dharancy S, Carbonell N, Bouvier A, et al. Transjugular intrahepatic portosystemic shunts with covered stents increase transplant-free survival of patients with cirrhosis and recurrent ascites. Gastroenterology. 2017;152:157–163. doi: 10.1053/j.gastro.2016.09.016.
    1. Ginés P, Arroyo V, Quintero E, Planas R, Bory F, Cabrera J, et al. Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites. Results of a randomized study. Gastroenterology. 1987;93:234–241. doi: 10.1016/0016-5085(87)91007-9.
    1. Runyon BA. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013;57:1651–1653. doi: 10.1002/hep.26359.
    1. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis J. Hepatol. 2010;53:397–417. doi: 10.1016/j.jhep.2010.05.004.
    1. Ginès A, Fernández-Esparrach G, Monescillo A, Vila C, Domènech E, Abecasis R, et al. Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis. Gastroenterology. 1996;111:1002–1010. doi: 10.1016/s0016-5085(96)70068-9.
    1. Bernardi M, Caraceni P, Navickis RJ, Wilkes MM. Albumin infusion in patients undergoing large-volume paracentesis: a meta-analysis of randomized trials. Hepatology. 2012;55:1172–1181. doi: 10.1002/hep.24786.
    1. Wilkinson SP, Smith IK, Williams R. Changes in plasma renin activity in cirrhosis: a reappraisal based on studies in 67 patients and “low-renin” cirrhosis. Hypertension. 1979;1:125–129. doi: 10.1161/01.hyp.1.2.125.
    1. Bauer JH. Age-related changes in the renin-aldosterone system. Physiological effects and clinical implications. Drugs Aging. 1993;3:238–245. doi: 10.2165/00002512-199303030-00005.
    1. James GD, Sealey JE, Müller F, Alderman M, Madhavan S, Laragh JH. Renin relationship to sex, race and age in a normotensive population. J Hypertens Suppl. 1986;4:S387–S389.
    1. Sharma AM, Schorr U, Oelkers W, Distler A. Effects of sodium salts on plasma renin activity and norepinephrine response to orthostasis in salt-sensitive normotensive subjects. Am J Hypertens. 1993;6:780–785. doi: 10.1093/ajh/6.9.780.
    1. Stern N, Sowers JR, McGinty D, Beahm E, Littner M, Catania R, et al. Circadian rhythm of plasma renin activity in older normal and essential hypertensive men: relation with inactive renin, aldosterone, cortisol and REM sleep. J Hypertens. 1986;4:543–550. doi: 10.1097/00004872-198610000-00005.
    1. Cohen EL, Conn JW, Rovner DR. Postural augmentation of plasma renin activity and aldosterone excretion in normal people. J Clin Invest. 1967;46:418–428. doi: 10.1172/JCI105543.
    1. Lijnen P, Fagard R, Staessen J, Amery A. Effect of chronic diuretic treatment on the plasma renin-angiotensin-aldosterone system in essential hypertension. Br J Clin Pharmacol. 1981;12:387–392. doi: 10.1111/j.1365-2125.1981.tb01231.x.
    1. Seifarth C, Trenkel S, Schobel H, Hahn EG, Hensen J. Influence of antihypertensive medication on aldosterone and renin concentration in the differential diagnosis of essential hypertension and primary aldosteronism. Clin Endocrinol (Oxf) 2002;57:457–465. doi: 10.1046/j.1365-2265.2002.01613.x.
    1. Cabrera J, Falcón L, Gorriz E, Pardo MD, Granados R, Quinones A, et al. Abdominal decompression plays a major role in early postparacentesis haemodynamic changes in cirrhotic patients with tense ascites. Gut. 2001;48:384–389. doi: 10.1136/gut.48.3.384.
    1. Campbell PJ, Skorecki KL, Logan AG, Wong PY, Leung WM, Greig P, et al. Acute effects of peritoneovenous shunting on plasma atrial natriuretic peptide in cirrhotic patients with massive refractory ascites. Am J Med. 1988;84:112–119. doi: 10.1016/0002-9343(88)90017-4.
    1. Shaw-Stiffel T, Campbell PJ, Sole MJ, Greig P, Wong PY, Blendis LM. Renal prostaglandin E2 and other vasoactive modulators in refractory hepatic ascites: response to peritoneovenous shunting. Gastroenterology. 1988;95:1332–1338. doi: 10.1016/0016-5085(88)90369-1.
    1. Greig PD, Langer B, Blendis LM, Taylor BR, Glynn MF. Complications after peritoneovenous shunting for ascites. Am J Surg. 1980;139:125–131. doi: 10.1016/0002-9610(80)90241-x.
    1. Peltekian KM, Wong F, Liu PP, Logan AG, Sherman M, Blendis LM. Cardiovascular, renal, and neurohumoral responses to single large-volume paracentesis in patients with cirrhosis and diuretic-resistant ascites. Am J Gastroenterol. 1997;92:394–399.
    1. Ruiz-del-Arbol L, Monescillo A, Jimenéz W, Garcia-Plaza A, Arroyo V, Rodés J. Paracentesis-induced circulatory dysfunction: mechanism and effect on hepatic hemodynamics in cirrhosis. Gastroenterology. 1997;113:579–586. doi: 10.1053/gast.1997.v113.pm9247479.
    1. Elsabaawy MM, Abdelhamid SR, Alsebaey A, Abdelsamee E, Obada MA, Salman TA, et al. The impact of paracentesis flow rate in patients with liver cirrhosis on the development of paracentesis induced circulatory dysfunction. Clin Mol Hepatol. 2015;21:365–371. doi: 10.3350/cmh.2015.21.4.365.
    1. Simon DM, McCain JR, Bonkovsky HL, Wells JO, Hartle DK, Galambos JT. Effects of therapeutic paracentesis on systemic and hepatic hemodynamics and on renal and hormonal function. Hepatology. 1987;7:423–429. doi: 10.1002/hep.1840070302.
    1. Caironi P, Gattinoni L. The clinical use of albumin: the point of view of a specialist in intensive care. Blood Transfus. 2009;7:259–267. doi: 10.2450/2009.0002-09.
    1. Caraceni P, Tufoni M, Bonavita ME. Clinical use of albumin. Blood Transfus. 2013;11(Suppl 4):s18–25. doi: 10.2450/2013.005s.
    1. Garcia-Martinez R, Caraceni P, Bernardi M, Gines P, Arroyo V, Jalan R. Albumin: pathophysiologic basis of its role in the treatment of cirrhosis and its complications. Hepatology. 2013;58:1836–1846. doi: 10.1002/hep.26338.
    1. Ginès P, Titó L, Arroyo V, Planas R, Panés J, Viver J, et al. Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology. 1988;94:1493–1502. doi: 10.1016/0016-5085(88)90691-9.
    1. Sola-Vera J, Miñana J, Ricart E, Planella M, González B, Torras X, et al. Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites. Hepatology. 2003;37:1147–1153. doi: 10.1053/jhep.2003.50169.
    1. Moreau R, Valla DC, Durand-Zaleski I, Bronowicki JP, Durand F, Chaput JC, et al. Comparison of outcome in patients with cirrhosis and ascites following treatment with albumin or a synthetic colloid: a randomised controlled pilot trail. Liver Int. 2006;26:46–54. doi: 10.1111/j.1478-3231.2005.01188.x.
    1. Alessandria C, Elia C, Mezzabotta L, Risso A, Andrealli A, Spandre M, et al. Prevention of paracentesis-induced circulatory dysfunction in cirrhosis: standard vs half albumin doses. A prospective, randomized, unblinded pilot study. Dig Liver Dis. 2011;43:881–886. doi: 10.1016/j.dld.2011.06.001.
    1. Pesaturo AB, Jennings HR, Voils SA. Terlipressin: vasopressin analog and novel drug for septic shock. Ann Pharmacother. 2006;40:2170–2177. doi: 10.1345/aph.1H373.
    1. Seo YS, Park SY, Kim MY, Kim JH, Park JY, Yim HJ, et al. Lack of difference among terlipressin, somatostatin, and octreotide in the control of acute gastroesophageal variceal hemorrhage. Hepatology. 2014;60:954–963. doi: 10.1002/hep.27006.
    1. Cavallin M, Kamath PS, Merli M, Fasolato S, Toniutto P, Salerno F, et al. Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome: A randomized trial. Hepatology. 2015;62:567–574. doi: 10.1002/hep.27709.
    1. Morelli A, Ertmer C, Rehberg S, Lange M, Orecchioni A, Cecchini V, et al. Continuous terlipressin versus vasopressin infusion in septic shock (TERLIVAP): a randomized, controlled pilot study. Crit Care. 2009;13:R130. doi: 10.1186/cc7990.
    1. Choudhury A, Kedarisetty CK, Vashishtha C, Saini D, Kumar S, Maiwall R, et al. A randomized trial comparing terlipressin and noradrenaline in patients with cirrhosis and septic shock. Liver Int. 2017;37:552–561. doi: 10.1111/liv.13252.
    1. Singh V, Kumar R, Nain CK, Singh B, Sharma AK. Terlipressin versus albumin in paracentesis-induced circulatory dysfunction in cirrhosis: a randomized study. J Gastroenterol Hepatol. 2006;21:303–307. doi: 10.1111/j.1440-1746.2006.04182.x.
    1. Moreau R, Asselah T, Condat B, de Kerguenec C, Pessione F, Bernard B, et al. Comparison of the effect of terlipressin and albumin on arterial blood volume in patients with cirrhosis and tense ascites treated by paracentesis: a randomised pilot study. Gut. 2002;50:90–94. doi: 10.1136/gut.50.1.90.
    1. McTavish D, Goa KL. Midodrine. A review of its pharmacological properties and therapeutic use in orthostatic hypotension and secondary hypotensive disorders. Drugs. 1989;38:757–777. doi: 10.2165/00003495-198938050-00004.
    1. Saló J, Ginès A, Quer JC, Fernández-Esparrach G, Guevara M, Ginès P, et al. Renal and neurohormonal changes following simultaneous administration of systemic vasoconstrictors and dopamine or prostacyclin in cirrhotic patients with hepatorenal syndrome. J Hepatol. 1996;25:916–923. doi: 10.1016/s0168-8278(96)80297-2.
    1. Singh V, Singh A, Singh B, Vijayvergiya R, Sharma N, Ghai A, et al. Midodrine and clonidine in patients with cirrhosis and refractory or recurrent ascites: a randomized pilot study. Am J Gastroenterol. 2013;108:560–567. doi: 10.1038/ajg.2013.9.
    1. Singh V, Dheerendra PC, Singh B, Nain CK, Chawla D, Sharma N, et al. Midodrine versus albumin in the prevention of paracentesis-induced circulatory dysfunction in cirrhotics: a randomized pilot study. Am J Gastroenterol. 2008;103:1399–1405. doi: 10.1111/j.1572-0241.2008.01787.x.
    1. Appenrodt B, Wolf A, Grünhage F, Trebicka J, Schepke M, Rabe C, Lammert F, et al. Prevention of paracentesis-induced circulatory dysfunction: midodrine vs albumin. A randomized pilot study. Liver Int. 2008;28:1019–1025. doi: 10.1111/j.1478-3231.2008.01734.x.
    1. Hardman JG, Limbird LE, Gilman AG. 11th edition. New York, NY: McGraw-Hill; 2006. Goodman and Gilman’s The Pharmacological Basis of Therapeutics; p. 248.
    1. Swan HJ. Noradrenaline, adrenaline, and the human circulation. Br Med J. 1952;1:1003–1006. doi: 10.1136/bmj.1.4766.1003.
    1. Nicholls KM, Shapiro MD, Van Putten VJ, Kluge R, Chung HM, Bichet DG, et al. Elevated plasma norepinephrine concentrations in decompensated cirrhosis. Association with increased secretion rates, normal clearance rates, and suppressibility by central blood volume expansion. Circ Res. 1985;56:457–461. doi: 10.1161/01.res.56.3.457.
    1. Saif RU, Dar HA, Sofi SM, Andrabi MS, Javid G, Zargar SA. Noradrenaline versus terlipressin in the management of type 1 hepatorenal syndrome: A randomized controlled study. Indian J Gastroenterol. 2018;37:424–429. doi: 10.1007/s12664-018-0876-3.
    1. Singh V, Kumar B, Nain CK, Singh B, Sharma N, Bhalla A, et al. Noradrenaline and albumin in paracentesis-induced circulatory dysfunction in cirrhosis: a randomized pilot study. J Intern Med. 2006;260:62–68. doi: 10.1111/j.1365-2796.2006.01654.x.
    1. Kulkarni AV, Sukriti S, Maiwall R, Jindal A, Ali R, Thomas S. Midodrine with albumin is safe and effective in preventing complications post-large volume paracentesis-an open labelled randomised controlled trial (NCT-03144713) Hepatology. 2018;68:72A–73A.
    1. Kwok CS, Krupa L, Mahtani A, Kaye D, Rushbrook SM, Phillips MG, et al. Albumin reduces paracentesis-induced circulatory dysfunction and reduces death and renal impairment among patients with cirrhosis and infection: a systematic review and meta-analysis. Biomed Res Int. 2013;2013:295153. doi: 10.1155/2013/295153.
    1. Simonetti RG, Perricone G, Nikolova D, Bjelakovic G, Gluud C. Plasma expanders for people with cirrhosis and large ascites treated with abdominal paracentesis. Cochrane Database Syst Rev. 2019;6:CD004039. doi: 10.1002/14651858.CD004039.pub2.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel