S1093 Large Volume Paracentesis in Patients With Cirrhosis and Acute Kidney Injury Is Not Associated With Worsening Renal Function

Abstract

INTRODUCTION: The effect of large volume paracentesis on renal function in patients with ongoing acute kidney injury (AKI) has not been studied in detail. Large volume paracentesis (LVP) is often avoided in these patients due to concerns of hypovolemia induced worsening renal injury. Conversely, some literature suggests that there may be an improvement in hemodynamics and abdominal pressures from LVP, resulting in improvement in AKI. We studied the association between volume removed on paracentesis and outcomes in patients with pre-existing AKI. METHODS: After IRB approval, a retrospective chart review of patients with cirrhosis undergoing paracentesis during admission at our tertiary care hospital was conducted. Patients were included if they had acute kidney injury at the time of paracentesis. RESULTS: The mean age of study participants was 60.02 years (SD 12.08); the population was predominantly male (63%). Alcohol was the most common etiology of cirrhosis (43%). Eighty-three patients had Child class C cirrhosis, the rest were class B. All patients had an AKI at the time of paracentesis. Pre-renal AKI was noted in 51 patients; 45 patients had KDIGO Stage 1 AKI, while 27 patients each had Stage 2 & 3. 29% of patients experienced a worsening of creatinine after paracentesis, with 19% requiring renal replacement therapy (RRT). Chronic kidney disease (CKD) was associated with worsening of AKI after paracentesis (P = 0.003). Age, gender, stage of AKI before procedure, Child Pugh Class, MELD-Na, Etiology of AKI were not associated with worsening renal function after paracentesis (P values < 0.05). LVP ( >4L) was performed on 52 patients while 48 patients had less than 4L removed; the groups were well matched in baseline characteristics including age, Child class, albumin administration, etiology of AKI and presence of CKD. There was no difference in the proportion of patients experiencing worsening of renal function after paracentesis in the large and small volume paracentesis groups (P = 0.397) or in the proportion of patients who had resolution of AKI (P = 0.553). Multivariable regression analysis was conducted incorporating age, gender, CKD, MELD score, and large vs small volume paracentesis, which revealed CKD as the only covariate significantly associated with worsening renal function after paracentesis (P = 0.005). CONCLUSION: Large volume paracentesis is not associated with worsening renal function or non-resolution of AKI in cirrhotics with acute kidney injury when compared to small volume paracentesis.