Peritoneal dialysis in patients with end-stage renal disease, chronic liver disease and ascites: A prospective observational study.

Abstract

Objectives: Patients with chronic liver disease (CLD) complicated by ascites may develop end-stage renal disease (ESRD), making selection of renal replacement therapy challenging. This study described the feasibility and clinical outcomes of peritoneal dialysis (PD) in selected patients with ESRD, CLD, and ascites.

Patients and methods: This prospective observational study included 51 selected patients with ESRD, CLD, and ascites and 55 patients with ESRD without CLD who underwent PD at a tertiary university hospital in Saudi Arabia. All underwent percutaneous insertion of a three-cuff PD catheter and received automated peritoneal dialysis (APD). Clinical outcomes recorded during observed follow-up are presented descriptively.

Results: Percutaneous catheter insertion was successful in all patients without bowel perforation, catheter migration, or major hemorrhage. Thirteen peritonitis episodes were recorded in the CLD group and 12 in the non-CLD group. The overall peritonitis rate was 0.10 episodes per patient-year; group-specific rates were 0.11 and 0.09 episodes per patient-year, respectively. None required catheter removal. A transient serum albumin decline of at least 0.5 g/dL was recorded in 5 and 4 patients, respectively. Early dialysate leakage occurred in 7/51 and 3/55 patients and was managed by temporary reduction of fill volume. During observed follow-up, 12/51 patients with CLD and 9/55 patients without CLD died.

Conclusions: Peritoneal dialysis was feasible in this selected cohort of patients with ESRD, chronic liver disease, and ascites. The observed adequacy values, complication counts, and crude mortality are reported descriptively. The findings should not be interpreted as establishing safety, effectiveness, equivalence, or superiority.