The impact of large-volume paracentesis on renal haemodynamics in cirrhotic patients with ascites

Abstract

Background and aim Ascites in liver cirrhosis is associated with a poor prognosis and impairment of the quality of life and may be complicated by hepatorenal syndrome. Renal functions and haemodynamic changes after large-volume paracentesis (LVP) in cirrhotic patients with tense ascites were evaluated. Patients and methods A total of 50 cirrhotic patients with tense ascites were divided into two groups: group I 25 patients without renal impairment and group II 25 patients with renal impairment (type II hepatorenal syndrome). Results In groups I and II, the serum creatinine decreased significantly 24 h after LVP (P < 0.05 and 0.01, respectively). The glomerular filtration rate and the urine output increased significantly 24 h after LVP (P < 0.05, P < 0.01 and P < 0.01, P < 0.05, respectively, in groups I and II). The renal artery resistive index (RI) was significantly higher in group II compared with group I (P < 0.01). LVP caused a significant increase in the cardiac output, the stroke volume and the cardiac index (P < 0.01) and a significant decrease in the RI in both groups (P < 0.01). There was significant correlation between serum and ascetic fluid electrolyte levels in all patients. Conclusion LVP causes a significant reduction of heart rate and mean arterial pressure, serum creatinine, blood urea nitrogen and RI with a significant glomerular filtration rate increase, but had no effect on the plasma renin activity.

Keywords

• Ascites, cirrhosis, hepatorenal syndrome, large-volume paracentesis, renal resistive index