Peritoneal Dialysis in End-Stage Renal Disease Patients with Liver Cirrhosis and Ascites

Abstract

End-stage renal disease (ESRD) patients with liver cirrhosis (LC) and ascites are in a critical status that is difficult to manage on conventional hemodialysis (HD) or continuous renal replacement therapy (CRRT) because of their hemodynamic instability and risk of bleeding. Peritoneal Dialysis (PD) offers them a viable alternative, along with a stable hemodynamic status, a lower risk of bleeding, a more flexible way of management, and a great reduction of staff as well as cost. Therefore, we collected 3 ESRD with liver cirrhosis and ascites patients to receive PD. The first patient was a 77-year-old man who had ESRD, hepatitis C virus (HCV) related LC and ascites, and congestive heart failure (CHF). He had received 6 months HD and shifted to PD because of shock during HD session and intractable ascites. The second patient was a 53-year-old man who had ERSD due to diabetes mellitus (DM) and hepatitis B virus (HBV) hepatitis with ascites. He chose PD because of advantage of home care. The third patient was a 75-year-old woman who had ESRD due to DM, CHF and HCV hepatitis with ascites. She chose PD because of hemodynamic instability. All of them tolerated PD well. Hemodynamic status was stable during PD even massive ascites (＞ 5,000 cc/d) was drained at the initial periods. No needs for anticoagulants, continuous solute clearance, caloric loading with glucose from dialysate, and drainage of ascites to maintain better life quality are advantages of PD.As patients of ESRD with LC and ascites or LC with ascites exacerbated to ESRD are frequently encountered in ICU, PD may be the better way than HD, Continuous Veno-Venous Hemofiltration (CVVH), or Slow Low Efficiency Daily Dialysis (SLEDD) to treat them.