BACKGROUND AND AIMS: Albumin is widely used as plasma expander to prevent circulatory dysfunction developed after large volume paracentesis (LVP) in cirrhotics with tense ascites. Considering the high cost of albumin, we decided to investigate prospectively whether hydroxyethyl stareh (HES) can prevent circulatory and renal dysfunction after paracentesis. METHODS: Twelve cirrhotics with tense ascites were randomly assigned to receive albumin (group I, n=6) or HES (group II, n=6). Salt and fluid were restricted and diuretics were withdrawn at least for two days. Then, LVP was performed and followed by slow infusion of plasma expander, 8 g/L ascites. Circulatory and renal dysfunction were monitored before, one and two days after LVP. RESULTS: Clinical characteristics, liver function and etiologies of cirrhosis in both groups were not different. The average amount of ascites removed from hoth groups was 4.3+/-0.98 L and 4.4+/-0.55 L, respectively. After LVP, hepatic encephalopathy, hemodynamic and renal dysfunction were not developed and the vital signs were not changed in any patients. Compared with the basal level, the amount of urine output increased immediately and two days after LVP in all patients of group I (592+/-80 -> 816+/-392 -> 1166+/-671 mL/day) and in group II (441+/-211 -> 683+/-354 -> 667+/-280 mL/day). No patients died of LVP cornplications during the admission. Conclusioes: These results suggest that HES is as effective and safe as albumin to prevent hemodynamic and renal dysfunction complicated by LVP in cirrhotics with tense ascites, and may be an alternative to albumin, the expensive plasma expander.