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Perit Dial Int 28(2): 118-122 2008
© 2008 International Society for Peritoneal Dialysis
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CLINICAL CASE COMMENTARY

PERITONEAL DIALYSIS IN THE COMPREHENSIVE MANAGEMENT OF END-STAGE RENAL DISEASE PATIENTS WITH LIVER CIRRHOSIS AND ASCITES: PRACTICAL ASPECTS AND REVIEW OF THE LITERATURE

Rafael Selgas, M.-Auxiliadora Bajo, Gloria Del Peso, Rafael Sánchez-Villanueva, Elena Gonzalez, Sara Romero, Elena Olivas and Covadonga Hevia

REDinREN (Spanish Renal Research Network) and Hospital Universitario La Paz, Madrid, Spain

Correspondence to: R. Selgas, Servicio de Nefrología, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain. rselgas.hulp{at}salud.madrid.org

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.

KEY WORDS: Ascites; liver cirrhosis; end-stage renal disease.

Received 11 November 2007; accepted 14 January 2008.






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