EFFICACY OF EXTRACORPOREAL ULTRAFILTRATION OF ASCITIC FLUID AS A TREATMENT OF REFRACTORY ASCITES

Background. Refractory ascites is recognized in patients with various conditions. Although intravenous reinjection of ascitic fluid after it s filtration and concentration (IRA) is an effective method of treatin g this condition, many associated side-effects have been reported. We performed extracorporeal ultrafiltration of ascitic fluid (EUA) to dem onstrate the efficacy and advantages of this method of treating refrac tory ascites. Methods. EUA was performed in seven patients with hepati c cirrhosis (3 cases), lupus nephritis, diabetic nephropathy, and carc inomatous peritonitis (2 cases) for a total of 122 sessions. IRA was p erformed in three of these seven patients for a total of 12 sessions. Results. The average volumes of ascitic fluid removed by EUA and IRA w ere 3.94 +/- 1.45 litres and 2.87 +/- 0.69 litres (mean+/-SD) respecti vely. Although chills and acute renal failure were recognized as compl ications of IRA in five and one sessions respectively, the only compli cation of EUA was severe intra-abdominal haemorrhage, which resolved s pontaneously. In spite of rapid and massive removal of ascitic fluid ( maximum 2.0 litres per 15 min), significant changes in blood pressure were not noted during EUA. In three patients (hepatic cirrhosis, lupus nephritis, and diabetic nephropathy), de novo production of ascitic f luid disappeared. In one patient with hepatic cirrhosis and chronic re nal failure on haemodialysis, 67 sessions of EUA have been performed u nder stable conditions. Three patients tone case of hepatic cirrhosis and two cases of carcinomatous peritonitis) died of their primary dise ases. Conclusions. We conclude that EUA is a useful method for the tre atment of massive refractory ascites.