title: Peritoneal dialysis in the comprehensive management of end-stage renal disease patients with liver cirrhosis and ascites: practical aspects and review of the literature.
abstract: 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.
authors.affiliation: REDinREN (Spanish Renal Research Network) and Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid, Spain. rselgas@salud.madrid.org
authors.forename: Rafael
authors.initials: R
authors.lastname: Selgas
authors.forename: M-Auxiliadora
authors.initials: MA
authors.lastname: Bajo
authors.forename: Gloria
authors.initials: G
authors.lastname: Del Peso
authors.forename: Rafael
authors.initials: R
authors.lastname: Sánchez-Villanueva
authors.forename: Elena
authors.initials: E
authors.lastname: Gonzalez
authors.forename: Sara
authors.initials: S
authors.lastname: Romero
authors.forename: Elena
authors.initials: E
authors.lastname: Olivas
authors.forename: Covadonga
authors.initials: C
authors.lastname: Hevia
mesh_terms: 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