Peritoneal Dialysis Use in Patients With Ascites: A Review

Link to article at PubMed

Am J Kidney Dis. 2021 Jun 15:S0272-6386(21)00660-0. doi: 10.1053/j.ajkd.2021.04.010. Online ahead of print.

ABSTRACT

Past few decades have seen steady increase in the prevalence of kidney failure (KF), needing kidney replacement therapy. Concomitantly, there has been progressive growth of heart failure and chronic liver disease, and many such patients develop ascites. Therefore, it is not uncommon to encounter patients with KF who concurrently have ascites. The presence of ascites adds many challenges in the management of KF. Poor hemodynamics make volume management difficult. Presence of coagulopathy, malnutrition and encephalopathy compounds the complexity of the management. Such patients do not tolerate hemodialysis well. However, several concerns have limited the use of peritoneal dialysis (PD), and hemodialysis remains the predominant dialysis modality in these patients. On the contrary, observational studies illustrate that PD provides hemodynamic stability and facilitates better volume management compared to hemodialysis. Moreover, PD obviates the need for therapeutic paracentesis by facilitating continuous drainage of ascites. PD potentially reduces hemorrhagic complications by avoiding routine anticoagulation use. Moreover, small studies suggest that outcomes such as peritonitis, and mechanical complications are comparable to that in KF-PD patients without ascites. PD does not affect transplant candidacy and these patients can successfully receive combined liver and kidney transplants. Hence, PD should be considered a viable dialysis option in KF patients with ascites.

PMID:34144102 | DOI:10.1053/j.ajkd.2021.04.010

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