TOTAL PARACENTESIS IN NONALCOHOLIC CIRRHOTICS WITH MASSIVE ASCITES - MIDTERM EFFECTS ON SYSTEMIC AND HEPATIC HEMODYNAMICS 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 as cites 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 ca rdiac output (6.1 +/- 0.3 vs 6.7 +/- 0.3 L/min, P < 0.001) and a decre ase in right atrial pressure (8.8 +/- 0.8 vs 4.3 +/- 0.7 mmHg, P < 0.0 01), systemic vascular resistance (1160 +/- 61 vs 976 +/- 50 dyne.s.cm (-5), P < 0.001), and wedged hepatic venous pressure 30 min after comp letion of paracentesis. After 5 days, right atrial pressure, systemic vascular resistance and wedged hepatic venous pressure returned to bas eline, while the cardiac output dropped to a level lower than the base line (5.7 +/- 0.7 L/min, P < 0.05). Hepatic venous pressure gradient h ad 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 m g/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 baseli ne. Based on these data, infusion of a volume expander may be necessar y for total paracentesis to avoid systemic haemodynamic complications in non-alcoholic cirrhosis.