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 marked activation of the sympathetic and the renin-angiotensin-aldosterone system. Total paracentesis is associated with a short-lived suppression of the renin-angiotensin-aldosterone system. Little information exists as to whether this favourable effect is parallelled by sympathoinhibition. Methods: In 16 Child C cirrhotic patients (age: 57.1±6.2 years, mean±SEM) with tense ascites we assessed the time course of the effects of total paracentesis 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 sympathetic nerve activity (microneurography, peroneal nerve). Measurements were obtained under baseline conditions, during staged removal of ascitic fluid (250 ml/min) and 24 h later. The patient remained supine throughout the study period. Results: Total paracentesis (10.6±1.3 l) induced a decrease in mean arterial pressure (from 95.0±2.6 mmHg to 88.2±3.2 mmHg, p<0.01), in heart rate (from 82.5±3.3 beats/min to 77.1±2.8 beats/min, p<0.01) and a reduction 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 patients muscle sympathetic nerve activity did not change during paracentesis (from 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-lasting phenomenon and to what extent plasma expansion with albumin contributes to this effects need to be further addressed.