{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T23:35:48Z","timestamp":1770507348552,"version":"3.49.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2008,1,15]],"date-time":"2008-01-15T00:00:00Z","timestamp":1200355200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"},{"start":{"date-parts":[[2008,1,15]],"date-time":"2008-01-15T00:00:00Z","timestamp":1200355200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                        <jats:title>Introduction<\/jats:title>\n                        <jats:p>Circulatory dysfunction in cirrhotic patients may cause a specific kind of functional renal failure termed hepato-renal syndrome (HRS). It contributes to the high incidence of renal failure in cirrhotic intensive care unit (ICU) patients. Fluid therapy may aggravate renal failure by increasing ascites and intra-abdominal pressure (IAP). This study investigates the short-term effects of paracentesis on haemodynamics and kidney function in volume resuscitated patients with HRS.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Methods<\/jats:title>\n                        <jats:p>Nineteen consecutive cirrhotic patients with HRS were studied. Circulatory parameters and renal function were analysed before and after plasma expansion and paracentesis. Haemodynamic monitoring was performed by transpulmonary thermodilution.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Results<\/jats:title>\n                        <jats:p>After infusion of 200 ml of 20% human albumin solution, mean arterial pressure (MAP) and central venous pressure remained unchanged. Global end-diastolic volume index (GEDVI) increased from 791 ml m<jats:sup>-2<\/jats:sup> (693 to 862) (median and 25th to 75th percentile) to 844 ml m<jats:sup>-2<\/jats:sup> (751 to 933). Cardiac index (CI) increased from 4.1 l min<jats:sup>-1<\/jats:sup> m<jats:sup>-2<\/jats:sup> (3.6 to 5.0) to 4.7 l min<jats:sup>-1<\/jats:sup> m<jats:sup>-2<\/jats:sup> (4.0 to 5.8), whereas systemic vascular resistance index (SVRI) decreased from 1,422 dyn s cm<jats:sup>-5<\/jats:sup> m<jats:sup>-2<\/jats:sup> (1,081 to 1,772) to 1,171 dyn s cm<jats:sup>-5<\/jats:sup> m<jats:sup>-2<\/jats:sup> (893 to 1,705). Creatinine clearance (CC) and fractional excretion of sodium (FeNa) were not affected. During paracentesis, IAP decreased from 22 mmHg (18 to 24) to 9 mmHg (8 to 12). MAP decreased from 81 mmHg (74 to 100) to 80 mmHg (71 to 89), and CI increased from 4.1 l min<jats:sup>-1<\/jats:sup> m<jats:sup>-2<\/jats:sup> (3.2 to 4.3) to 4.2 l min<jats:sup>-1<\/jats:sup> m<jats:sup>-2<\/jats:sup> (3.6 to 4.7), whereas SVRI decreased from 1,639 dyn s cm<jats:sup>-5<\/jats:sup> m<jats:sup>-2<\/jats:sup> (1,168 to 2,037) to 1,301 dyn s cm<jats:sup>-5<\/jats:sup> m<jats:sup>-2<\/jats:sup> (1,124 to 1,751). CC during the 12-hour interval after paracentesis was significantly higher than during the 12 hours before (33 ml min<jats:sup>-1<\/jats:sup> (16 to 50) compared with 23 ml min<jats:sup>-1<\/jats:sup> (12 to 49)). CC remained elevated for the rest of the observation period. FeNa increased after paracentesis but returned to baseline levels after 24 hours.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Conclusion<\/jats:title>\n                        <jats:p>Paracentesis with parameter-guided fluid substitution and maintenance of central blood volume may improve renal function and is safe in the treatment of ICU patients with hepato-renal failure.<\/jats:p>\n                     <\/jats:sec>","DOI":"10.1186\/cc6765","type":"journal-article","created":{"date-parts":[[2008,1,15]],"date-time":"2008-01-15T19:13:36Z","timestamp":1200424416000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":80,"title":["Effects of plasma expansion with albumin and paracentesis on haemodynamics and kidney function in critically ill cirrhotic patients with tense ascites and hepatorenal syndrome: a prospective uncontrolled trial"],"prefix":"10.1186","volume":"12","author":[{"given":"Andreas","family":"Umgelter","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfgang","family":"Reindl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katrin S","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Franzen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konrad","family":"Stock","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roland M","family":"Schmid","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfgang","family":"Huber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2008,1,15]]},"reference":[{"key":"6198_CR1","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1002\/hep.1840080532","volume":"8","author":"RW Schrier","year":"1988","unstructured":"Schrier RW, Arroyo V, Bernardi M, Epstein M, Henriksen JH, Rod\u00e9s J: Peripheral arterial vasodilation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis.\n                           Hepatology 1988, 8: 1151-1157. 10.1002\/hep.1840080532","journal-title":"Hepatology"},{"key":"6198_CR2","doi-asserted-by":"publisher","first-page":"1310","DOI":"10.1136\/gut.2006.107789","volume":"56","author":"F Salerno","year":"2007","unstructured":"Salerno F, Gerbes A, Gin\u00e8s P, Wong F, Arroyo V: Definition, diagnosis and treatment of hepatorenal syndrome in cirrhosis. 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