Peritoneal Dialysis Use in Patients With Ascites: A Review.
| Autor: | Rajora N; Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas., De Gregorio L; Division of Transplant Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas., Saxena R; Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: ramesh.saxena@utsouthwestern.edu. |
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| Jazyk: | angličtina |
| Zdroj: | American journal of kidney diseases : the official journal of the National Kidney Foundation [Am J Kidney Dis] 2021 Nov; Vol. 78 (5), pp. 728-735. Date of Electronic Publication: 2021 Jun 16. |
| DOI: | 10.1053/j.ajkd.2021.04.010 |
| Abstrakt: | The past few decades have seen steady increase in the prevalence of kidney failure needing kidney replacement therapy. Concomitantly, there has been progressive growth of heart failure and chronic liver disease, and many such patients develop ascites. Therefore, it is not uncommon to encounter patients with kidney failure who concurrently have ascites. The presence of ascites adds many challenges in the management of kidney failure. Poor hemodynamics make volume management difficult. The presence of coagulopathy, malnutrition, and encephalopathy compounds the complexity of the management. Such patients do not tolerate hemodialysis well. However, several concerns have limited the use of peritoneal dialysis (PD), so hemodialysis remains the predominant dialysis modality in these patients. However, observational studies have illustrated that PD provides hemodynamic stability and facilitates better volume management compared with hemodialysis. Moreover, PD obviates the need for therapeutic paracentesis by facilitating continuous drainage of ascites. PD potentially reduces hemorrhagic complications by avoiding routine anticoagulation use. Moreover, small studies have suggested that outcomes such as peritonitis and mechanical complications are comparable to those in PD patients without ascites. PD does not affect transplant candidacy, and these patients can successfully receive combined liver and kidney transplants. Hence, PD should be considered a viable dialysis option in kidney failure patients with ascites. (Copyright © 2021 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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