| Abstract: | We compared the clinical efficacy and safety of large-volumeparacentesis and dialytic ultrafiltration in the treatment ofrefractory ascites in cirrhotic patients. A group of cirrhoticsubjects (age 49–80 years) were randomly allocated toeither continuous paracentesis (1–1.5 1/hour) or dialyticultrafiltration until disappearance of ascites. Each patientwas maintained on bed rest, fluid restriction (1 1/day) anda low (25 mmol/day) sodium diet for 14 days. Five patients (threein the paracentesis group and two in dialytic ultrafiltrationgroup) developed massive ascites 3–5 months later, andreceived the crossover treatment. The average volume of fluidremoved was similar in the two groups (4.70±1.47 1 fordialytic ultrafiltration versus 4.69±1.84 1 for paracentesis),but the treatment period was significantly shorter with dialyticultrafiltration. The plasma creatinine significantly increasedthree days after paracentesis but did not increase in patientstreated with dialytic ultrafiltration. There was an initialfall in mean arterial pressure during the first two hours ofeither treatment; a further fall in blood pressure was observedwith paracentesis but not with dialytic ultrafiltration. Pretreatmentplasma renin activity was elevated, but was not altered by eithertreatment. Plasma atrial natriuretic peptide levels were inthe high-normal range before treatment. Paracentesis was associatedwith a delayed fall in plasma atrial natriuretic peptide, whiledialytic ultrafiltration induced a modest but significant rise.No complication was experienced with dialytic ultrafiltrationin the two weeks following treatment, but four of the eightpatients who underwent paracentesis had developed severe complications.Dialytic ultrafiltration of ascitic fluid is a safe procedurein cirrhotic patients. Large-volume paracentesis without intravenouscolloid reinfusion causes complications and carries the potentialrisk of reducing the effective intravascular volume. |
