Noradrenaline and albumin in paracentesis‐induced circulatory dysfunction in cirrhosis: a randomized pilot study

Abstract.Objective.  Therapeutic paracentesis in patients with cirrhosis is associated with a circulatory dysfunction. Intravenous albumin has been used to prevent the circulatory dysfunction; however, the use of albumin is controversial and costly. Splanchnic vasodilation is mainly responsible for circulatory dysfunction in these patients. There are no reports of use of noradrenaline, a vasoconstrictor, on the prevention of paracentesis‐induced circulatory dysfunction in patients with cirrhosis. Therefore, we studied the preventive effect of noradrenaline on paracentesis‐induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis and compared it with that of intravenous albumin in a randomized pilot study.Methods.  Forty patients with cirrhosis and tense ascites underwent therapeutic paracentesis with albumin or noradrenaline in a randomized controlled trial at a tertiary centre. Effective arterial blood volume was assessed by measuring plasma renin activity at baseline and at 6 days after treatment.Results.  Effective arterial blood volume as indicated by plasma renin activity before and 6 days after paracentesis did not differ in the two groups (20.62 ± 10.27–22.02 ± 10.15 ng mL−1 h−1; P = 0.11 in the albumin group and 19.66 ± 8.91–20.78 ± 9.41 ng mL−1 h−1; P = 0.37 in the noradrenaline group). Plasma aldosterone concentration before and 6 days after paracentesis were also similar in both groups (1196.5 ± 434.2–1217.0 ± 405.7 pg mL−1; P = 0.7 in the albumin group and 1206.0 ± 522.5–1273.5 ± 444.8 pg mL−1; P = 0.22 in the noradrenaline group). The cost of noradrenaline treatment was significantly lower when compared with that of albumin (P < 0.001).Conclusions.  Noradrenaline is as effective as albumin in preventing paracentesis‐induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis, but at a fraction of the cost.