REINFUSION AND CONCENTRATION OF ASCITIC FLUID DURING HEMODIALYSIS IN A CIRRHOTIC UREMIC PATIENT

Management of tense ascites in cirrhotic patients on chronic hemodialy sis is still a matter of speculation. A considerable problem with thes e patients is the frequent occurrence of hypotension during ultrafiltr ation. We describe a patient in whom ascitic fluid was reinfused on th e arterial line and ultrafiltrated during standard treatment by using a single dialysis monitor, standard dialysis (SD) lines, and a standar d hollow-fiber dialyzer. After 30 to 60 minutes of dialysis, with the patient lying on his left side, a gauge #16 IV catheter was introduced into the left lower abdomen and connected to the reinfusion line. The ascitic fluid was pumped from the abdomen to the arterious inlet of t he coil at 500 to 2,000 mL/hr and ultrafiltered. In an individual pati ent, 13 sessions of ascites reinfusion-ultrafiltration dialysis (ARD) were performed over 3 months and compared with 18 SD sessions performe d during the same period. In all procedures, the same SD equipment was used. During ARD, the average weight loss was 2.9 (SD 1.0) kg compare d with a weight loss of 0.3 (0.04) kg during SD (P < 0.01). Baseline m ean blood pressure was similar in both procedures; after starting dial ysis, mean arterial pressure (MAP) dropped by an average of 15 mm Hg a t 30 and 60 minutes. Subsequently, during ARD, MAP increased progressi vely by an average of 20 mm Hg at 180 minutes, whereas MAP did not cha nge significantly during SD. Comparison between procedures by nonparam etric one-way analysis of variance showed that body weight became sign ificantly different at 120, 150, and 180 minutes (P < 0.01) and MAP at 150 and 180 minutes (P < 0.02 and P < 0.01,respectively). No major co mplications occurred. During ARD, on average urea reduction rate was 6 7%. ARD may represent an effective and safe combination between hemodi alysis and the palliative treatment of tense ascites in cirrhotic urem ic patients. (C) 1998 by the National Kidney Foundation, Inc.