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Effects of alfapump™ system on kidney and circulatory function in patients with cirrhosis and refractory ascites
Author(s) -
Solà Elsa,
SanchezCabús Santiago,
Rodriguez Ezequiel,
Elia Chiara,
Cela Raquel,
Moreira Rebeca,
Pose Elisa,
SánchezDelgado Jordi,
Cañete Nuria,
MoralesRuiz Manuel,
Campos Francisco,
Balust Jaume,
Guevara Mónica,
GarcíaValdecasas Juan Carlos,
Ginès Pere
Publication year - 2017
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.24763
Subject(s) - medicine , renal function , ascites , paracentesis , cirrhosis , kidney , mean arterial pressure , urology , urinary system , plasma renin activity , refractory (planetary science) , circulatory system , blood pressure , cardiology , gastroenterology , heart rate , renin–angiotensin system , physics , astrobiology
The alfa pump system has been proposed as a new treatment for the management of refractory ascites. The system removes ascites from the peritoneal cavity to urinary bladder, producing a continuous low‐volume paracentesis. The aim of the study is to investigate the effects of treatment with the alfa pump™ system on kidney and circulatory function in patients with cirrhosis and refractory ascites. This was a prospective study including 10 patients with cirrhosis and refractory ascites. Primary outcomes were changes in glomerular filtration rate (GFR), as assessed by isotopic techniques, and changes in circulatory function assessed by arterial pressure, cardiac output, and activity of vasoconstrictor systems. Secondary outcomes were the need for large‐volume paracentesis and adverse events. Follow‐up was 1 year. GFR decreased significantly from 67 mL/minute/1.73 m 2 (41‐90 mL/minute/1.73 m 2 ) at baseline to 45 mL/minute/1.73 m 2 (36‐74 mL/minute/1.73 m 2 ) at month 6 ( P = 0.04). Mean arterial pressure and cardiac output did not change significantly; however, there was a marked increase in plasma renin activity and norepinephrine concentration (median percent increase with respect to baseline +191% and 59%, respectively). There were 68 episodes of complications of cirrhosis in 8 patients during follow‐up, the most frequent being acute kidney injury. In conclusion, treatment with alfa pump™ system was associated with marked activation of endogenous vasoconstrictor systems and impairment of kidney function. The chronological relationship observed between kidney impairment and vasoconstrictor systems activation after device insertion suggests a cause‐effect relationship, raising the possibility that treatment with alfa pump impairs effective arterial blood volume mimicking a postparacentesis circulatory dysfunction syndrome. In this context, the potential role of albumin in counteracting these effects should be investigated in future studies. Liver Transplantation 23 583–593 2017 AASLD .