TOTAL PARACENTESIS WITH DEXTRAN-40 VS DIURETICS IN THE TREATMENT OF ASCITES IN CIRRHOSIS - A RANDOMIZED CONTROLLED-STUDY

The aim of the current study was to compare total paracentesis associa ted with dextran-40 infusion with diuretics in the treatment of tense ascites in patients with cirrhosis. Eighty patients were randomly allo cated to two groups: 40 patients were treated with paracentesis plus d extran-40 infusion (8 g per liter of ascitic fluid removed), and 40 pa tients with diuretics. After treatment patients were discharged with d iuretics, and patients developing tense ascites during follow up (54+/ -4 weeks) were treated according to their initial schedule. Paracentes is was more effective than diuretics in mobilizing the ascitic fluid. The incidence of complications was significantly higher (p<0.05) in th e diuretic group (38%) than in the paracentesis group (15%). This diff erence was mainly due to a higher incidence of hepatic encephalopathy in the former group (30% vs. 2.5%). A significantly higher incidence o f hepatic encephalopathy was also observed in the diuretic group durin g the follow-up readmissions for ascites recurrence. There were no sig nificant differences between the two treatment groups in the probabili ty of survival after inclusion. Plasma renin activity and plasma aldos terone concentration measured before and 2 and 6 days after paracentes is in 20 randomly selected patients increased significantly (p<0.05) ( baseline values: 5.3+/-1.4 ng.ml(-1).h(-1) and 63+/-21 ng/dl; 48 h aft er paracentesis: 11.7+/-3.9 ng.ml(-1).h(-1) and 99+/-31 ng/dl; 6 days after paracentesis: 10.9+/-3.ng.ml(-1).h(-1) and 110+/-27 ng/dl). Thes e results confirm that paracentesis is more effective than diuretic th erapy in the treatment of patients with cirrhosis with tense ascites a nd is associated with a lower incidence of complications. In addition, they suggest that dextran-40 is less effective than other previously assessed plasma expanders in preventing the impairment of effective in travascular volume after paracentesis. (C) Journal of Hepatology.