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Updated: Dec 24, 2025

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Published on: December 10, 2020
Pathophysiology and Prevention of Paracentesis-induced Circulatory Dysfunction: A Concise Review
Anand V Kulkarni1, Pramod Kumar1, Mithun Sharma1
1Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India.
Abstract:
Annually, 10% of cirrhotic patients with ascites develop refractory ascites for which large-volume paracentesis (LVP) is a frequently used therapeutic procedure. LVP, although a safe method, is associated with circulatory dysfunction in a significant percentage of patients, which is termed paracentesis-induced circulatory dysfunction (PICD). PICD results in faster reaccumulation of ascites, hyponatremia, renal impairment, and shorter survival. PICD is diagnosed through laboratory results, with increases of >50% of baseline plasma renin activity to a value ≥4 ng/mL/h on the fifth to sixth day after paracentesis. In this review, we discuss the pathophysiology and prevention of PICD.
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