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PPCD: A complication in cirrhosis from large-volume paracentesis, causing renal stress, preventable with albumin.

Updated: Jan 23

PPCD in cirrhotic patients, marked by increased plasma renin activity and RAAS activation after removing over 5 liters of ascitic fluid, leads to renal vasoconstriction and can be prevented with albumin infusion.

Question: Why is the risk of Post-Paracentesis Circulatory Dysfunction (PPCD) a concern in large-volume paracentesis procedures in patients with cirrhosis?

In PPCD, removing large volumes of over 5 liters of ascitic fluid triggers RAAS overactivity, leading to fluid retention and potential kidney strain and hypertension.

There is no single universally accepted set of criteria, the following framework can be useful in identifying and diagnosing PPCD PPCD Uniqcret's Criteria: First, Exclusion of Other Causes. Rule out other potential causes of the symptoms, such as cardiac events, bleeding, or infection.


Clinical Features

Laboratory Features

Additional Considerations


RAAS overactivity in PPCD PPCD in cirrhosis, caused by removing large volumes of sodium-rich ascitic fluid, can excessively activate the RAAS system. This overactivity leads to increased aldosterone release, causing the kidneys to reabsorb more water and sodium. The resulting fluid retention can strain the kidneys, possibly leading to renal dysfunction and hypertension.

How albumin administration combats Post-Paracentesis Circulatory Dysfunction (PPCD)

Effect on Hormones

Reducing RAAS Overactivity

Effect on Vessels

Enhancing Blood Vessel Tone

Decrease Endothelial permeability

Effect on Serum osmolality

Boosting Oncotic Pressure

All of these work together and it result is

Volume Expansion and Blood Pressure Stabilization

Improving Splanchnic Circulation

Supporting Kidney Function

Miscellaneous benefits



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