Intravascular volume regulation in cirrhotic patients with functional renal failure

Central volume expansion is an important component of treating renal dysfunction associated with advanced chronic liver disease. Experiments using HWI in these patients emphasize the importance of increasing central vascular filling as a way to normalize renal function through multiple physiologic mechanisms. However, the desired improvement in renal function is not always obtained with HWI, especially in patients with greater degrees of hepatic dysfunction, central volume depletion, and activation of neurohumoral support systems. This may, in part, be related to reflexive decreases in systemic vascular resistance during immersion. The development of techniques to expand central arterial volume while maintaining systemic vascular resistance and mean arterial pressure may add to the beneficial effects on renal function in cirrhotics. Pneumatic compression of the lower extremities may be one way of achieving the desired circulatory effects. Adjunctive therapy with splanchnic vasoconstrictors may be necessary in patients with marked vasodilation but they often have undesirable intrarenal actions.