SAT-151 POSITIVE RENAL OUTCOMES OF LARGE VOLUME PARACENTESIS IN CIRRHOTIC PATIENTS WITH SPONTANEOUS BACTERIAL PERITONITIS, A NEPHROLOGIST'S PERSPECTIVE

Abstract

Spontaneous bacterial peritonitis (SBP) occurs in 10-30% of cirrhotic patients and is associated with high mortality rate in this vulnerable population. It is associated with high incidence of acute kidney injury (AKI) and hepatorenal syndrome (HRS), and large number of nephrological input is been sought from our medicine and hepatology section colleagues. In a low to lower middle income country where availability of resources remain a big hurdle, newer therapeutic options with less use of interventions are always been sought. The case is also true for the developed world where healthcare related costs needs to be cut down. Large volume paracentesis (LVP) decreases the burden of infective fluid. Outcomes of LVP in SBP patients has not been clearly addressed in previous studies. Furthermore, in the absence of more viable therapeutic options for preventing kidney impairment in SBP, the management really looms around time and need for renal replacement therapy (RRT). This study will assess the outcome of LVP in patients with SBP, both in terms of mortality, length of stay and effect on renal function This cross-sectional study was conducted in the Medicine Unit of Aga Khan University Hospital. A total of 113 patients with diagnosed SBP were assessed. Among these patients 61 underwent LVP while 51 were managed conservatively. LVP was done as per routine practice of safety and monitoring. All the patients received intravenous Albumin. Baseline and 48 hours clinical outcomes (including creatinine and ascitic fluid total leucocytes (TLC) count) were compared. The development of AKI and post-paracentesis induced circulatory dysfunction (PPCD) were also assessed and model for end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) scores were also calculated. Need for renal replacement therapy for the acute disturbances of acid base balance, development of severe and progressive renal failure and continuous renal replacement therapy was also noted. There was statistically significant improvement in post 48 hours creatinine among patients undergoing LVP (p-value <0.001) whereas no significant improvement was seen in patients without LVP (p-value 0.32). Similar improvements were seen for special care unit stay and total length of stay in patients with LVP, need for RRT and incidences of AKI and HRS, as evidenced by the table. LVP in patients with SBP translates into significantly positive outcomes in terms of length of hospital stay, special care unit stay, need for RRT and development of AKI and HRS. Hence as per a nephrologist's perspective, LVP should be considered as a favored therapeutic option in patients with SPB.