Reinfusion and concentration of ascitic fluid during hemodialysis in a cirrhotic uremic patient.
Management of tense ascites in cirrhotic patients on chronic hemodialysis is still a matter of speculation. A considerable problem with these patients is the frequent occurrence of hypotension during ultrafiltration. We describe a patient in whom ascitic fluid was reinfused on the arterial line and ultrafiltrated during standard treatment by using a single dialysis monitor, standard dialysis (SD) lines, and a standard hollow-fiber dialyzer. After 30 to 60 minutes of dialysis, with the patient lying on his left side, a gauge #16 IV catheter was introduced into the left lower abdomen and connected to the reinfusion line. The ascitic fluid was pumped from the abdomen to the arterious inlet of the coil at 500 to 2,000 mL/hr and ultrafiltered. In an individual patient, 13 sessions of ascites reinfusion-ultrafiltration dialysis (ARD) were performed over 3 months and compared with 18 SD sessions performed during the same period. In all procedures, the same SD equipment was used. During ARD, the average weight loss was 2.9 (SD 1.0) kg compared with a weight loss of 0.3 (0.04) kg during SD (P < 0.01). Baseline mean blood pressure was similar in both procedures; after starting dialysis, mean arterial pressure (MAP) dropped by an average of 15 mm Hg at 30 and 60 minutes. Subsequently, during ARD, MAP increased progressively by an average of 20 mm Hg at 180 minutes, whereas MAP did not change significantly during SD. Comparison between procedures by nonparametric one-way analysis of variance showed that body weight became significantly different at 120, 150, and 180 minutes (P < 0.01) and MAP at 150 and 180 minutes (P < 0.02 and P < 0.01, respectively). No major complications occurred. During ARD, on average urea reduction rate was 67%. ARD may represent an effective and safe combination between hemodialysis and the palliative treatment of tense ascites in cirrhotic uremic patients.
Unitá Operativa di Nefrologia e Dialisi, Monselice, Italy. carletto.c@iol.it
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D000368:Aged; D001202:Ascitic Fluid; D017583:Hemodiafiltration; D006801:Humans; D007262:Infusions, Intravenous; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications* / Q000628:therapy; D008297:Male; D006435:Renal Dialysis; D014511:Uremia / Q000150:complications / Q000628:therapy*