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Ascites due to heart failure (HF) is associated with poor life expectancy. Management of refractory ascites is often performed by large volume serial paracentesis. The use of peritoneal dialysis catheter placement for ascites management has been described with controversial results. We describe our center experience using Tenckhoff (TNK) catheter in management of refractory ascites due to heart failure.
Observational and retrospective cohort study in a single third level center, from January 2015 to August 2021. Patients with refractory ascites due to HF with or without hepatic failure were included. A TNK catheter was placed by a surgeon or an interventional nephrologist. Follow-up was made a month after insertion and until outcomes (kidney failure or death) occurred.
Sixteen patients were included, eleven were men. Heart failure etiologies were ischemic heart disease and valvulopathy in 8 and 7 patients respectively. Comorbidities were diabetes and hypertension, 6 patients in each one. Upon admission 81.25% of patients developed acute kidney injury, requiring renal replacement therapy in 38.4%. Average weight decreased from 69 to 62.2 Kg after TNK placement (p 0.017). We demonstrated improvement of HF functional class after TNK placement, NYHA class was improved from 12.5% in class II to 66.7% in class I. Likewise more severe NYHA stages improved class IV (87.5%) to class III (33.3%) (p 0.034). Tricuspid insufficiency was improved from 68.7% to 47.3% (p 0.041). There were no significant changes in LVEF, sPAP or pericardial effusion. Emergency visits and hospitalizations did not change significantly. eGFR and urinary volume improved from 28 ml/min/1.73 m2 and 1200 ml/24 h to 35 ml/min/1.73 m2 (p 0.025) and 1483 ml/24 h (p 0.052), respectively (Figure 1). Complications from catheter placement were hematic fluid (25%), leakage (12.5%) and accidental catheter displacement (6.2%). Peritonitis rate was 1 episode per-19 patient-months and 0.62 episodes per patient-year. TNK was removed in 37.5% of cases due to peritonitis in 3 cases and HF improvement in 2, with posterior replacement in 3 o them. Kidney failure requiring chronic renal replacement therapy occurred in 25%. Death occurred in 25% due to cardiovascular events in 2 cases and one due to gastrointestinal hemorrhage.
TKN placement is viable and safe in the management of refractory ascites in HF. Prospective clinical trials are needed to assess long-term survival and quality of life.