Gines P, Tito L, Arroyo V, et al. Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology 1988;94:1493-1502. This study showed the role of albumin in patients undergoing repeated large-volume paracentesis (4-6L per day until the disappearance of ascites). Infusion of albumin was not associated with significant changes in renal function, plasma renin activity, and plasma aldosterone whereas patients without albumin showed significant increase in BUN, plasma renin activity and plasma aldosterone. The albumin group had fewer patients who developed renal impairment (defined as >50% increase in Cr or BUN) and/or hyponatremia as compared to the control group (1.7% vs. 20.8% P=0.01). This study showed no direct mortality benefit with albumin, and the use of albumin with its inherent cost remains controversial. Additional studies have shown that albumin may have little benefit in paracenteses less than 5L.