ASCITIC FLUID ULTRAFILTRATION A RESCUE OPTION FOR SYMPTOMATIC ASCITES

 

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ASCITIC FLUID ULTRAFILTRATION A RESCUE OPTION FOR SYMPTOMATIC ASCITES

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Mahesh
Kota
Mahesh Kota mahesh9700502390@gmail.com YASHODA HOSPITAL NEPHROLOGY HYDERABAD India *
Nikhil HR dr.nikhilhr@gmail.com YASHODA HOSPITAL INTERVENTIONAL RADIOLOGY HYDERABAD India -
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Patients with refractory ascites due to advanced liver disease, intra abdominal malignancy, end stage renal disease(ESRD) and severe heart failure are on multiple diuretics/repeated large volume paracentesis sessions, however they are not getting symptomatic relief and also getting side effects like dyselectrolytemia/worsening residual renal function due to diuretics, they are also getting bacterial peritonitis due multiple large volume paracentesis(LVP) sessions.We subjected some of these patients to ascitic fluid ultrafiltration (AFU) to see the clinical benefits.

AFU was done in 12 patients.They were subjected to 14F pigtail catheter placement in peritoneal cavity, run the ascitic fluid at a speed of 120ml/min through blood pump/lowflux dialyser/conventional hemodialysis machine/keep the blood clamp at air detector off/keep the dialysate off during the procedure.Targeted fluid removed in each session was 3000ml to 4000ml.

Of the total 12 patients who underwent AUF therapy 7 of them was having advanced liver disease ,in them 5 patients were off diuretics/gained good urine output/improved renal function at the time of discharge ,however 2 of them requiring long term AUF was subjected to Tenckhoff catheter placement and they were on weekly once AFU therapy.Three patients with intra abdominal malignancy were subjected to AUF ,though all of them expired after six months due to primary disease ,they got good symptomatic relief from abdominal pain/breathing difficulty/decreased hospital visits for LVP and their quality of life(QOL) was much better with AFU.One patient with severe heart failure improved ejection fraction ,off diuretics at the time of discharge however as he was requiring multiple AFU sessions he was subjected to  Tenckhoff catheter placement and he was put on weekly once long dwell peritoneal dialysis with 7.5% Icodextrin.One patient with ESRD requiring repeated AFU sessions  was subjected to Tenckhoff catheter placement in peritoneal cavity / tunnelled catheter into right internal jugular vein and put on maintenance hemodialysis and weekly once AFU therapy.No side effects was seen during AFU therapy in any one of these patients.


AFU therapy is safe, not associated with side effects, improves residual renal function, improves ejection fraction, improves QOL, decreases diuretic requirement and decreases hospital visit for LVP sessions.

It decreases the albumin and other protein loss that occur during LVP sessions.

It deceases the need for hemodialysis and act as a bridge therapy to facilitate liver transplantation in patient with advanced liver disease.


Kewords