Daily home-based low-volume paracentesis associated with greater risk of complications

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1. For patients with refractory ascites, daily home-based low-volume paracentesis was associated with a greater risk of hyponatremia and acute kidney injury compared to repeated large-volume paracentesis.

Evidence Rating Level: 3 (Average)

Refractory ascites is a clinical sign of end-stage liver disease, with few effective treatment options. Most patients will undergo repeated large-volume paracentesis (LVP) with albumin infusions. Home-based small-volume paracentesis is becoming more common, though previous research suggests there may be increased risks of AKI, hyponatremia, and hospital admissions with this practice. This retrospective cohort study aimed to examine the incidence of complications associated with daily small-volume drainage. 250 patients with refractory ascites were followed for 90 days. Only patients with contraindications to transjugular intrahepatic portosystemic shunt were included in the study. 72% of patients underwent daily small-volume drainage (minimum 1.5 L/ day) and 28% received repeated LVPs. The study endpoints were a 90-day incidence of hyponatremia and AKI. Compared to repeated LVPs, daily drainage was associated with an increased risk of hyponatremia (HR, 2.17; 95% CI, 1.24-3.78; P = .006) and AKI (HR, 1.43; 95% CI, 1.01-2.16; P = .04). There was no increased risk found for patients draining less than 1.5 L/ day. This study suggests that clinicians should be cautious of advising at-home drainage exceeding 1.5L/ day without albumin infusions. This study is mainly limited by the small sample size and the retrospective research design. To more accurately determine the risks associated with different drainage methods, future research may expand on this data by recruiting a larger study population or adopting a prospective or randomized control trial design. Nonetheless, study findings suggest that there are likely ongoing complications associated with home-based low-volume paracentesis that may inhibit it from being a viable therapeutic option for some patients. 

Click to read the study in JAMA Network Open

Image: PD

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