Adequate Volume Restitution with Midodrine Versus Albumin in Patients with Refractory Ascites Undergoing Large-Volume Paracentesis: A Comparative Analysis
Main Article Content
Abstract
Large-volume paracentesis (LVP) is a cornerstone in the management of refractory ascites in cirrhotic patients, but it is associated with significant hemodynamic complications, including paracentesis-induced circulatory dysfunction (PICD). Current guidelines advocate for the use of albumin to mitigate these risks; however, its high cost and limited availability have prompted the exploration of alternative therapies such as midodrine, an α1-adrenergic agonist with vasoconstrictive properties. This study aims to compare the efficacy and safety of midodrine versus albumin in maintaining hemodynamic stability and preventing PICD post-LVP. We conducted a prospective, randomized trial involving patients with refractory ascites, evaluating hemodynamic parameters, renal function, and clinical outcomes. Our findings suggest that midodrine offers a cost-effective alternative to albumin with comparable efficacy in volume restitution, although certain patient subgroups may benefit more from specific interventions. Further research is warranted to optimize patient selection and treatment protocols.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Garbuzenko, DV, Arefyev, NO. Current approaches to the management of patients with cirrhotic ascites. World J Gastroenterol. 2019; 25(28): 3738–52.
II. Pedersen, JS, Bendtsen, F, Møller, S. Management of cirrhotic ascites. Ther Adv Chronic Dis. 2015; 6: 124-137.
III. Arroyo, V, Gines, P, Gerbes, AL, Dudley, FJ, Gentilini, P, Laffi, G et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology (Baltimore, Md.). 1996; 23: 164-76.
IV. Fortune B, Cardenas A. Ascites, refractory ascites and hyponatremia in cirrhosis. Gastroenterology Rep (Oxf). 2017; 5: 104–112.
V. Kim JH. What we know about paracentesis induced circulatory dysfunction? Clin Mol Hepatol .2015; 21(4), 349–351.
VI. European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010; 53:397–417.
VII. Gines P, Tito L, Arroyo V, Planas R, Panes J, Viver J et al. Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology. 1988; 94: 1493- 1502.
VIII. Sola-Vera J, Such J. Understanding the mechanisms of paracentesis-induced circulatory dysfunction. Eur J Gastroenterol Hepatol. 2004; 295-298.
IX. Salo J, Gines, A, Gines P, Piera C, Jimenez W, Guevara M et al. Effect of therapeutic paracentesis on plasma volume and transvascular escape rate of albumin in patients with cirrhosis. J Hepatol. 1997; 27: 645–653.
X. Pinto PC, Amerian J, Reynolds, TB. Large-volume paracentesis in nonedematous patients with tense ascites: its effect on intravascular volume. Hepatology (Baltimore, Md.). 1988; 8: 207–210.
XI. Ruiz-del-Arbol L, Monescillo A, Jimenez W, Garcia-Plaza A, Arroyo V, Rodes J et al. Paracentesis-induced circulatory dysfunction: mechanism and effect on hepatic hemodynamics in cirrhosis. Gastroenterology. 1997; 113: 579–586.
XII. Angeli P, Volpin R, Piovan D, Bortoluzzi A, Craighero R, Bottaro S et al. Acute effects of the oral administration of midodrine, an alpha- adrenergic agonist, on renal hemodynamics and renal function in cirrhotic patients with ascites. Hepatology (Baltimore, Md.). 1998; 28:937-43.
XIII. Katzung BG, Trevor, AJ. Basic and Clinical Pharmacology. 14th Ed. 2017 McGraw-Hill Education / Medical.
XIV. Yosry A, Soliman ZA, Eletreby R, Hamza I, Ismail A, Elkady MA et al. Oral midodrine is comparable to albumin infusion in cirrhotic patients with refractory ascites undergoing large-volume paracentesis: results of a pilot study. Eur J Gastroenterol Hepatol. 2019; 31: 345-51.
XV. Hamdy H, ElBaz AA, Hassan A, Hassanin O. Comparison of midodrine and albumin in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients: a randomized pilot study. J Clin Gastroenterol. 2014; 48: 184–188.
XVI. Appenrodt B, Wolf A, Grunhage F, Trebicka J, Schepke M, Rabe C et al. Prevention of paracentesis-induced circulatory dysfunction: midodrine vs albumin. A randomized pilot study. Liver Int. 2008; 28: 1019–25.