HEMODYNAMIC-EFFECTS OF PERITONEOVENOUS SHUNTS IN HEMODIALYSIS-PATIENTS WITH ASCITES

Ascites in hemodialysis patients has been reported in association with systemic diseases, such as cirrhosis or congestive heart failure, and as an idiopathic form, Regardless of the etiology, these patients oft en are refractory to treatment with intradialytic ultrafiltration beca use of recurrent hypotensive episodes, In this report we describe the hemodynamic effects of peritoneovenous shunts (PVSs) in three hemodial ysis patients with ascites refractory to conventional treatment. One p atient had idiopathic ascites and the other two had associated liver d isease, Patients were monitored for lowest blood pressure, number of i ntradialytic hypotensive episodes, number of grams of albumin infused to treat hypotensive episodes, interdialytic weight gain, and hemodyna mic stability (defined as the difference between the predialysis mean arterial pressure and the lowest intradialytic mean arterial pressure) . In all three patients the hemodynamic parameters stabilized after PV S placement despite equal or greater ultrafiltration during dialysis ( due to a significant increase in the lowest measured intradialytic blo od pressure), The total number of hypotensive episodes decreased from 219 prior to PVS placement to zero after shunt placement, The need for albumin infusion during hemodialysis (for blood pressure support) dec reased (significantly in two patients), as did the volume of ascites i n all three patients, One patient required PVS replacement secondary t o infection, which was the only complication, We believe that refracto ry ascites in end-stage renal disease patients can be successfully tre ated by placement of a PVS, which often results in relief of the ascit es and significant improvement in intradialytic hemodynamic stability. (C) 1996 by the National Kidney Foundation, Inc.