Introduction:
Refractory ascites secondary to chronic liver disease among ESRD patients are a major source of morbidity and mortality. Hemodialysis is frequently interrupted due to intradialytic hypotension and other complications which make ultrafiltration removal among CLD patients, a big challenge. This results in sub-optimal clearance which translates into poor quality of life along with recurrent admissions. CAPD in these patients is effective in providing a good clearance as well as removal of ascites with adequate ultrafiltration removal.
Methods:
This was a retrospective study from 1st January 2018 to 31st March 2023 , which included the patients with CLD and refractory ascites on maintenance hemodialysis who underwent CAPD catheterisation in the department of nephrology in a tertiary care centre in northern India. Refractory ascites were defined as the need for >5 therapeutic paracentesis in the last 3 months after optimal clinical, dietary and fluid management.
Results:
Over a period of five years, 34 patients were included in the analysis to assess the efficacy of Continuous Ambulatory Peritoneal Dialysis (CAPD) for ascites management in chronic liver disease. Open catheter insertion was performed in 31 out of 34 patients. Serum albumin levels increased from 2.98 ± 0.4 g/dL at baseline to 3.1 ± 0.28 g/dL at 12 months (p = 0.21).rate of peritonitis was significantly increased in the CAPD patients when compared to the spontaneous bacterial peritonitis before the initiation of CAPD in the last 12 months(3 episodes vs 9 episodes; p=0.04).PD-related complications at one year included one omental wrap, three pericatheter leaks, and one umbilical hernia. At the 12-month follow-up, 32 patients survived. One patient died from myocardial infarction, and another experienced severe hepatic encephalopathy and aspiration pneumonia.
Conclusions:
PD was well tolerated in patients with refractory ascites, presenting no additional hypoalbuminemia risk. Continuous multidisciplinary monitoring for malnutrition remains critical. Peritonitis risk was elevated relative to SBP in HD patients yet was on par with typical PD rates, without an increase in hospital admissions.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.