title: Peritoneal ultrafiltration for refractory fluid overload and ascites due to pulmonary arterial hypertension.
abstract: Pulmonary hypertension is a common finding in patients with advanced liver disease. Similarly, among patients with advanced pulmonary arterial hypertension, right heart failure leads to congestive hepatopathy. Diuretic resistant fluid overload in both advanced pulmonary hypertension and chronic liver disease is a demanding challenge for physicians. Venous congestion and ascites-induced increased intra-abdominal pressure are essential regarding recurrent hospitalization, morbidity and mortality. Due to impaired right-ventricular function, many patients cannot tolerate extracorporeal ultrafiltration. Peritoneal dialysis, a well-established, hemodynamically tolerated treatment for outpatients may be a good alternative to control fluid status. We present a patient with pulmonary arterial hypertension and congestive hepatopathy hospitalized for over 3 months due to ascites induced refractory volume overload treated with peritoneal ultrafiltration. We report the treatment benefits on fluid balance, cardiorenal and pulmonary function, as well as its safety. In conclusion, we report a case in which peritoneal ultrafiltration was an efficient treatment option for refractory ascites in patients with congestive hepatopathy.
authors.affiliation: Department of Internal Medicine II, Division of Nephrology, University Clinic Giessen and Marburg (UKGM), Campus Giessen, Giessen, Germany.
authors.forename: Faeq
authors.initials: F
authors.lastname: Husain-Syed
authors.affiliation: International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy.
authors.forename: María-Jimena
authors.initials: MJ
authors.lastname: Muciño-Bermejo
authors.affiliation: International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
authors.affiliation: Department of Internal Medicine II, University Clinic Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL) - Campus Giessen, Giessen, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Seeger
authors.affiliation: Department of Internal Medicine II, Division of Nephrology, University Clinic Giessen and Marburg (UKGM), Campus Giessen, Giessen, Germany.
authors.forename: Horst-Walter
authors.initials: HW
authors.lastname: Birk
mesh_terms: D001201:Ascites / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008875:Middle Aged; D010530:Peritoneal Dialysis; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance