Adequate Volume Restitution with Midodrine Versus Albumin in Patients with Refractory Ascites Undergoing Large-Volume Paracentesis: A Comparative Analysis

Large-volume paracentesis (LVP) is a cornerstone in the management of refractory ascites in cirrhotic patients, but it is associated with significant hemodynamic complications, including paracentesis-induced circulatory dysfunction (PICD). Current guidelines advocate for the use of albumin to mitigate these risks; however, its high cost and limited availability have prompted the exploration of alternative therapies such as midodrine, an α1-adrenergic agonist with vasoconstrictive properties. This study aims to compare the efficacy and safety of midodrine versus albumin in maintaining hemodynamic stability and preventing PICD post-LVP. We conducted a prospective, randomized trial involving patients with refractory ascites, evaluating hemodynamic parameters, renal function, and clinical outcomes. Our findings suggest that midodrine offers a cost-effective alternative to albumin with comparable efficacy in volume restitution, although certain patient subgroups may benefit more from specific interventions. Further research is warranted to optimize patient selection and treatment protocols.