Peritoneal dialysis in the comprehensive management of end-stage renal disease patients with liver cirrhosis and ascites: practical aspects and review of the literature.
The treatment of cirrhotic patients with ascites and end-stage renal disease is complex, due mainly to decreased effective arterial volume and hemodynamic instability. Peritoneal dialysis as a continuous therapy represents an alternative to hemodialysis-related intolerance. We report on our experience and that of others with cirrhotic patients with ascites treated by peritoneal dialysis. Hemodynamic tolerance was excellent in all patients and solute and water peritoneal transport increased to above the normal range in almost all cases. Morbidity and mortality were related principally to liver disease and other comorbidities. Peritoneal protein losses, initially high, decreased over time, maintaining serum albumin within the low normal range. The incidence of peritonitis was similar or slightly higher than usual in these patients, with peculiar etiology. The experiences with peritoneal dialysis suggest consideration of this treatment as the first choice for cirrhotic patients with ascites and that need to start dialysis.
Selgas
Rafael
R
REDinREN (Spanish Renal Research Network) and Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid, Spain. rselgas@salud.madrid.org
Bajo
M-Auxiliadora
MA
Del Peso
Gloria
G
Sánchez-Villanueva
Rafael
R
Gonzalez
Elena
E
Romero
Sara
S
Olivas
Elena
E
Hevia
Covadonga
C
D000328:Adult; D001201:Ascites / Q000150:complications*; D002408:Catheters, Indwelling; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D009752:Nutritional Status; D010530:Peritoneal Dialysis / Q000009:adverse effects; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010538:Peritonitis / Q000209:etiology / Q000628:therapy