Early effects of total paracentesis and albumin infusion on muscle sympathetic nerve activity in cirrhotic patients with tense ascites

Background/Aims: Cirrhotic patients with ascites are characterized by a mar ked activation of the sympathetic and the renin-angiotensin-aldosterone sys tem. Total paracentesis is associated with a short-lived suppression of the renin-angiotensin-aldosterone system. Little information exists as to whet her this favourable effect is parallelled by sympathoinhibition. Methods: In 16 Child C cirrhotic patients (age: 57.1+/-6.2 years, mean+/-SE M) with tense ascites we assessed the time course of the effects of total p aracentesis followed by intravenous albumin (6-8 g/l of ascites) on beat-to -beat mean arterial pressure (Finapres), heart rate, plasma norepinephrine, epinephrine (high performance liquid chromatography) and muscle sympatheti c nerve activity (microneurography, peroneal nerve). Measurements were obta ined under baseline conditions, during staged removal of ascitic fluid (250 ml/min) and 24 h later. The patient remained supine throughout the study p eriod. Results: Total paracentesis (10.6+/-1.31) induced a decrease in mean arteri al pressure (from 95.0+/-2.6 mmHg to 88.2+/-3.2 mmHg, p<0.01), in heart rat e (from 82.5+/-3.3 beats/min to 77.1+/-2.8 beats/min, p<0.01) and a reducti on in plasma norepinephrine values (from 782+/-133 pg/ml to 624+/-103 pg/ml , p<0.01), which were substantially maintained 24 h later. In eight patient s muscle sympathetic nerve activity did not change during paracentesis (fro m 65+/-7.1 bursts/min to 65+/-7.4 bursts/min, p=NS), but a marked reduction was observed 24 h later (48.4+/-5.6 bursts/min, p<0.01). Conclusions: These data provide the first evidence that total paracentesis exerts an acute marked sympathoinhibitory effect. Whether this is a long-la sting phenomenon and to what extent plasma expansion with albumin contribut es to this effects need to be further addressed.