SYMPTOMATIC ASCITES AFTER DISCONTINUATION OF CONTINUOUS PERITONEAL-DIALYSIS

Objective: To analyze pathogenetic associations, clinical features, ma nagement, and outcome of ascites following discontinuation of continuo us peritoneal dialysis (CPD). Design: Retrospective analysis of sympto matic ascites, defined as ascites requiring at least one therapeutic p aracentesis, developing in patients who discontinued CPD. Setting: Dia lysis unit of one tertiary care center. Participants: Twelve patients with 13 episodes of symptomatic ascites diagnosed soon after (a few cl ays to 2 months) discontinuation of CPD. Interventions: Diagnostic tes ts to characterize the pathogenesis of ascites; management of ascites by hemodialysis or CPD. Main Outcome Measures: Evolution of clinical f eatures and nutritional parameters, survival. Results: Ascites was inf ectious in 3 episodes (nontuberculous mycobacterial peritonitis) and n oninfectious in the remaining 10 episodes. Serum-to-ascites albumin co ncentration gradient (AG) was 6.3 +/- 1.5 g/L in infectious ascites an d 17.3 +/- 2.7 g/L (>11 g/L in every episode) in noninfectious ascites . Infectious ascites was managed with hemodialysis, prolonged courses of antimicrobial agents, and repeated paracentesis. Paracentesis cease d after 3 - 9 months. The patients were alive after 52 +/- 19 months. Seven episodes of noninfectious ascites were managed by hemodialysis a nd repeated paracentesis. Five patients died within 6 months from card iac causes or sepsis. The remaining 2 patients died after 14 and 16 mo nths from cardiac causes. Three episodes of noninfectious ascites in 2 patients were treated by restarting CPD within 2 - 5 months. Patients were alive at 16.9 +/- 13.2 months. They were asymptomatic and achiev ed fluid control. On the same CPD schedule, peritoneal clearances of u rea and creatinine and normalized protein nitrogen appearance were unc hanged between the initial and restarted CPD. Serum albumin was 33.3 /- 2.5 g/L at the end of the first CPD period, 23.6 +/- 2.5 g/L soon a fter restarting CPD, and 31.3 +/- 5.5 g/L 4 months after restarting CP D. Conclusions: Noninfectious ascites after discontinuation of CPD is often characterized by an AG> 11 g/L, suggesting portal hypertension. Restarting CPD in noninfectious ascites may be associated with improve ment in ascites symptomatology and nutritional parameters and with sat isfactory survival.