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There are other controversial proposed indications for albumin expansion, such as non-BSP infections,96,97 ascites22 and encephalopathy.21,98 Prevention of paracentesis-induced circulatory dysfunction After LVP, intra-abdominal pressure abruptly drops, which increases venous return to the right atrial pressure, with consequent increase in cardiac output and stroke volume.99 However, this transient increase in cardiac output induces an excessive drop in peripheral vascular resistance, while increasing intrahepatic vascular resistance.100 As a consequence, blood is sequestrated into the peripheral circulation resulting in a decrease in effective circulating volume and in arterial pressure.100103 Interestingly, this impairment in effective blood volume does not associate with an increase in transvascular escape of albumin.102 A persistent reactivation of renin angiotensin aldosterone system (RAAS) occurs as a counteracting mechanism that can last for months,101 which can result in recurrence of ascites, hyponatremia, HRS and decreased survival.101,104107 Paracentesis-induced circulatory dysfunction (PICD) has been defined as at least 50% increase in plasma renin activity up to level higher than 4 ng/mL/h at the 6th day after paracentesis.104 PICD occurs in one third of patients submitted to LVP and does not revert spontaneously.105 The first study showing a benefit of albumin administration in the prevention of PICD was performed, more than 30 years ago, by Gines, et al.104 Albumin infusion abrogated an increase in plasma renin activity after paracentesis, and prevented hyponatremia and deterioration in renal failure