Total paracentesis in non-alcoholic cirrhotics with massive ascites: Mid-term effects on systemic and hepatic haemodynamics and renal function

Single total paracentesis (4.8–11 L) was performed in 23 patients with hepatitis B surface antigen (HBsAg)-positive cirrhosis and massive ascites and its effects on systemic and hepatic haemodynamics and renal function were examined over 5 days. Severe hypotension occurred in six (26.1%) patients from 6 to 54 h after paracentesis. In the remaining 17 patients, compared to the baseline, there was an increase in the cardiac output (6.1 ± 0.3 vs 6.7 ± 0.3 L/min, P <0.001) and a decrease in right atrial pressure (8.8 ± 0.8 vs 4.3 ± 0.7 mmHg, P <0.001), systemic vascular resistance (1160 ± 61 vs 976 ± 50 dyne·s·cm ^?5, P <0.001), and wedged hepatic venous pressure 30 min after completion of paracentesis. After 5 days, right atrial pressure, systemic vascular resistance and wedged hepatic venous pressure returned to baseline, while the cardiac output dropped to a level lower than the baseline (5.7 ± 0.7 L/min, P<0.05). Hepatic venous pressure gradient had returned to baseline after 5 days. Serial tests of serum creatinine level showed an increase from day 3 (1.34 ± 0.14 vs 1.04 ± 0.10 mg/dL, P <0.05). On day 5, creatinine clearance (55.7 ± 5.4 vs 41.9 ± 5.3 mL/min, P <0.05) and effective renal plasma flow (351 ± 32 vs 293 ± 29 mL/min, P <0.05) were decreased, compared to the baseline. Based on these data, infusion of a volume expander may be necessary for total paracentesis to avoid systemic haemodynamic complications in non-alcoholic cirrhosis.