Abstract: FR-PO0120
Impact of Paracentesis on the Course of AKI in Cirrhosis
Session Information
- AKI: Epidemiology and Clinical Trials
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- David Espinosa, Ricardo, Ochsner Health, New Orleans, Louisiana, United States
- Zarama, Cristina, Ochsner Health, New Orleans, Louisiana, United States
- Punukollu, Pooja A., UQ-Ochsner Clinical School, New Orleans, Louisiana, United States
- Chalmers, Dustin R., Louisiana State University, Baton Rouge, Louisiana, United States
- Varghese, Vipin, University of Michigan Health System, Ann Arbor, Michigan, United States
- Velez, Juan Carlos Q., UQ-Ochsner Clinical School, New Orleans, Louisiana, United States
Group or Team Name
- Ochsner Nephrology.
Background
The effect of paracentesis (PARA) on the course of an established acute kidney injury (AKI) in cirrhosis remains unclear. While fluid evacuation may cause hemodynamic instability, it may also reduce intraabdominal pressure and favor renal perfusion. Furthermore, the volume of PARA is often limited as means to reduce the risk of kidney dysfunction despite lack of evidence linking volume of PARA with worsening AKI risk. Thus, we sought to examine these conundrums.
Methods
Leveraging an inpatient database of patients with cirrhosis and AKI seen on consultation, we extracted those who underwent PARA within the period between the day of the consult up to 7 days later. We measured the change in daily slope of serum creatinine (sCr) between 48 prior to PARA and 48 hrs after PARA. Worsened AKI was defined as a positive change in sCr slope ≥ +0.3 mg/dL/day, whereas Improved AKI as negative change in sCr slope ≤ -0.3 mg/dL/day. Change in sCr slope between +0.2 and -0.2 mg/dL/day were deemed Neutral. We also examined the impact of albumin therapy and volume of PARA.
Results
Among 302 patients, 158 underwent PARA during the AKI (44% hepatorenal syndrome). sCr pre-PARA was not available in 14. Thus, 144 patients entered the analyses. Mean age was 55, 39% women, 77% white race. At the time of AKI, mean values of sCr and MELD were 3.1 mg/dL and 35, respectively. As expected, the amount of albumin (g) administration correlated with the volume of PARA (mL) (r=0.23, p=0.007). Post-PARA, Worsened AKI occurred in 28 (19.4%), whereas Improved AKI occurred in 47 (32.6%) (p=0.011). PARA had a Neutral effect in 69 (48%). The median sCr slope (mg/dL/day) pre and post PARA were +0.1 and +0.03, respectively, with a median delta -0.1. There was no significant relationship between the AKI trajectory and either the volume of PARA (3963 vs. 4742 mL, for Worsened vs. Improved AKI, p=0.12) or the amount of albumin (54 vs. 47 g, for Worsened vs. Improved AKI, p=0.49).
Conclusion
During AKI in cirrhosis, PARA is more often associated with improvement rather than worsening of sCr trajectory. Neither the volume of PARA nor the amount of prophylactic albumin exerts an impact on renal outcome. Decisions regarding PARA should be tailored to symptoms or individual clinical needs.