Should Albumin Be Given to Cirrhotic Patients Who Undergo Large-Volume Paracentesis?

Summary and Comment |
August 30, 2012

Should Albumin Be Given to Cirrhotic Patients Who Undergo Large-Volume Paracentesis?

  1. Neil H. Winawer, MD, SFHM

A meta-analysis suggests that it is helpful.

  1. Neil H. Winawer, MD, SFHM

Although several practice guidelines advocate administration of intravenous (IV) albumin during large-volume paracentesis (LVP), the data behind these recommendations is not robust. Researchers performed a meta-analysis of 17 randomized controlled trials (1225 total patients) to evaluate whether albumin is appropriate for acute treatment of cirrhotic patients with tense ascites who undergo LVP.

In all trials, average volume of ascites removed was >5 L. Among the trials in which albumin was compared with no treatment, the incidence of postparacentesis circulatory dysfunction (PCD; a complication associated with ascites recurrence and hepatorenal syndrome, defined as a ≥50% increase in plasma renin activity) was 17%, versus 73% with no treatment (number needed to treat [NNT], 2). Among the trials in which albumin was compared with alternative treatments (i.e., artificial colloids, crystalloids, or vasoconstrictors), the incidence of PCD was 15% with albumin and 31% with alternatives (NNT, 5). The incidence of hyponatremia in albumin-treated patients was 4%, versus 17% in those who received no treatment (NNT, 8). Comparing albumin therapy to alternative treatments yielded a hyponatremia incidence of 8% versus 15% (NNT, 14). In only one trial did researchers examine albumin versus no treatment in relation to mortality, and no difference was noted. However, in studies of albumin versus alternative treatments, mortality was slightly lower with albumin (12% vs 14%).

Comment

Despite the substantial cost of IV albumin, practitioners likely should use this agent (6–8 g IV albumin/L of ascites removed) during LVP of >5 L in patients with tense ascites to prevent morbidity. This finding validates current guidelines.

Citation(s):

Reader Comments (1)

Barbara Herring retired

my daughter is having up to 10 L removed and her Kidney Doctor has recommended having Albumin during the procedure. Her next procedure is scheduled to happen in 4 day.s. what do you mean by morbidity. I am not a medical person.

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