{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:02:58Z","timestamp":1791352978437,"version":"4.3.1"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>The potential association of low-volume paracentesis of less than 5 L with complications in patients with ascites remains unclear, and individuals with cirrhosis and refractory ascites (RA) treated with devices like Alfapump or tunneled-intraperitoneal catheters perform daily low-volume drainage without albumin substitution. Studies indicate marked differences regarding the daily drainage volume between patients; however, it is currently unknown if this alters the clinical course.<\/jats:p><\/jats:sec>Objective<\/jats:title>To determine whether the incidence of complications, such as hyponatremia or acute kidney injury (AKI), is associated with the daily drainage volume in patients with devices.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study of patients with liver cirrhosis, RA, and a contraindication for a transjugular intrahepatic portosystemic shunt who received either device implantation or standard of care (SOC; ie, repeated large-volume paracentesis with albumin infusion), and were hospitalized between 2012 and 2020 were included. Data were analyzed from April to October 2022.<\/jats:p><\/jats:sec>Interventions<\/jats:title>Daily ascites volume removed.<\/jats:p><\/jats:sec>Main outcomes and Measures<\/jats:title>The primary end points were 90-day incidence of hyponatremia and AKI. Propensity score matching was performed to match and compare patients with devices and higher or lower drainage volumes to those who received SOC.<\/jats:p><\/jats:sec>Results<\/jats:title>Overall, 250 patients with RA receiving either device implantation (179 [72%] patients; 125 [70%] male; 54 [30%] female; mean [SD] age, 59 [11] years) or SOC (71 [28%] patients; 41 [67%] male; 20 [33%] female; mean [SD] age, 54 [8]) were included in this study. A cutoff of 1.5 L\/d or more was identified to estimate hyponatremia and AKI in the included patients with devices. Drainage of 1.5 L\/d or more was associated with hyponatremia and AKI, even after adjusting for various confounders (hazard ratio [HR], 2.17 [95% CI, 1.24-3.78]; P<\/jats:italic>\u2009=\u2009.006; HR, 1.43 [95% CI, 1.01-2.16]; P<\/jats:italic>\u2009=\u2009.04, respectively). Moreover, patients with taps of 1.5 L\/d or more and less than 1.5 L\/d were matched with patients receiving SOC. Those with taps of 1.5 L\/d or more had a higher risk of hyponatremia and AKI compared with those receiving SOC (HR, 1.67 [95% CI, 1.06-2.68]; P<\/jats:italic>\u2009=\u2009.02 and HR, 1.51 [95% CI, 1.04-2.18]; P<\/jats:italic>\u2009=\u2009.03), while patients with drainage of less than 1.5 L\/d did not show an increased rate of complications compared with those receiving SOC.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study, clinical complications in patients with RA performing low-volume drainage without albumin infusion were associated with the daily volume drained. Based on this analysis, physicians should be cautious in patients performing drainage of 1.5 L\/d or more without albumin infusion.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.22048","type":"journal-article","created":{"date-parts":[[2023,7,6]],"date-time":"2023-07-06T15:32:30Z","timestamp":1688657550000},"page":"e2322048","source":"Crossref","is-referenced-by-count":13,"title":["Daily Low-Volume Paracentesis and Clinical Complications in Patients With Refractory Ascites"],"prefix":"10.1001","volume":"6","author":[{"given":"Tammo L.","family":"Tergast","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Griemsmann","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Stockhoff","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"Port","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Heidrich","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Cornberg","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany"},{"name":"German Centre for Infection Research, HepNet Study-House of the German Liver Foundation, Hannover, Germany"},{"name":"Centre for Individualised Infection Medicine, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heiner","family":"Wedemeyer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany"},{"name":"German Centre for Infection Research, HepNet Study-House of the German Liver Foundation, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrike","family":"Lenzen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Richter","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elmar","family":"Jaeckel","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany"},{"name":"Department for Liver Transplantation at University Health Network of the University of Toronto, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Maasoumy","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany"},{"name":"German Centre for Infection Research, HepNet Study-House of the German Liver 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