Ascites reinfusion using the Rhodiascit apparatus—clinical experience and coagulation abnormalities

Wilkinson, Stephen; Henderson, J.; Davidson, Anne; Williams, Roger

doi:10.1136/pgmj.51.598.583

Cited by 27 publications

(3 citation statements)

References 1 publication

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“…This device consists of sterile disposable intravenous tubing, a pump, and a membrane that concentrates the ascitic fluid 2-to 4-fold before its reinfusion into a peripheral vein. Experience with this procedure has been extensive in Europe but much less so in the United States [32]. Complications include fever, sepsis, congestive heart failure, coagulopathy, and gastrointestinal bleeding.…”

Section: Treatment With Extracorporeal Devicesmentioning

confidence: 99%

Management of Renal Complications of Liver Disease

Epstein

Pérez

Oster

1988

J Intensive Care Med

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Included among the most important renal complica tions of liver disease is progressive sodium retention leading to the formation of edema and ascites and the hepatorenal syndrome (HRS). When ascites is refractory to conventional treatment, the use of invasive proce dures such as reinfusion or dialytic ultrafiltration of as cites or the peritoneovenous shunt may be indicated. The possibility that continuous arteriovenous hemo filtration may be useful in removing fluid in patients who would not otherwise tolerate traditional hemodialysis has, because of its recent availability, been raised. Ther apy of HRS continues to be one of the most intriguing and vexing problems in clinical medicine. The use of hemodialysis with polyacrylonitrile membranes may be helpful in certain patients with HRS, especially in those with acute reversible liver injury. Although the peri toneovenous shunt has been reported to correct the renal functional disturbance, the results of the only two controlled studies available are inconclusive. Liver disease is frequently accompanied by a variety of alterations in renal function and electrolyte me tabolism [1]. These complications of liver disease range in severity from the clinically unimportant to problems requiring prompt and vigorous thera peutic intervention. In the present review, empha sis is placed on the management of the abnor malities of renal sodium handling and on acute intrinsic renal failure (ATN) and the hepatorenal syndrome (HRS), which often supervene in patients with severe liver disease. The reader is referred to Epstein [1,2] and Perez and colleagues [3] for more detailed expositions of the use of dialysis and ultrafiltration in treating renal complications of liver disease.

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Section: Treatment With Extracorporeal Devicesmentioning

confidence: 99%

Management of Renal Complications of Liver Disease

Epstein

Pérez

Oster

1988

J Intensive Care Med

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“…The concentration of fibrinogen and plasminogen in ascitic fluid is lower than that expected from their molecular weights, whereas the concentrations of plasminogen activators and fibrin/fibrinogen degradation products are higher than in plasma [31]. The infusion of ascitic fluid into the general circulation, either directly or by the insertion of a peritoneovenous shunt, is often associated with disseminated intravascular coagulation, as manifested by a marked reduction in platelet count, prothrombin time and fibrinogen concentration, and an increase in the plasma concentrations of fibrin degradation products, thus confirming the procoagulant activity of ascitic fluid [33,34]. In addition, there is apparently intraperitoneal coagulation in cirrhotic patients as the concentration of fibrin monomers in ascitic fluid is almost 10 times higher than in plasma [32].…”

Section: Characteristics Of Cirrhotic Ascitesmentioning

confidence: 99%

Pathogenesis, Diagnosis and Treatment of Ascites in Cirrhosis

Arroyo¹,

Terra²,

Ruíz-del-Árbol³

2007

Textbook of Hepatology

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“…In the past, reported complications limited the use of this procedure [49,50]. Using the Rhodiascit de vice for ascitic reinfusion, major complica tions such as left ventricular failure, variceal hemorrhage, and encephalopathy with coma were observed in 8% of the patients, with 1 % mortality rate [51].…”

Section: Rein Fusion O F Concentrated Ascitesmentioning

confidence: 99%

Treatment of Ascites: Old and New Remedies

Inturri¹,

Graziotto²,

Rossaro³

1996

Dig Dis

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Ascites is a common complication of chronic liver disease. Treatment of the underlying liver disease with modalities such as abstinence from alcohol in Laennec’s cirrhosis, phlebotomy in hemochromatosis, copper removal in Wilson’s disease, and steroids in autoimmune liver disease, can improve survival in many patients. In addition, therapy of ascites alleviates the symptoms and improves the quality of life of the patients, and probably decreases the incidence of life-threatening conditions including spontaneous bacterial peritonitis and hepatorenal syndrome. The mean survival rate at 2 years is approximately 50%. Precipitating factors such as gastrointestinal bleeding, nonsteroidal anti-inflammatory drugs and infections, should be identified, since most of them can be corrected. Most cirrhotics with ascites can be managed with a ‘step-by-step’ approach, including dietary salt restrictions, aldosterone antagonists, and loop diuretics. When tense or refractory ascites is present, large-volume paracentesis is safe and effective. Peritoneovenous shunting (i.e. Denver, LeVeen) is less frequently used because of perioperative morbidity and mortality, and thrombotic complications with occlusion of the stent. Reinfusion of concentrated ascites is of potential benefit and has been used in Europe. Transjugular intrahepatic portosystemic shunt (TIPS) is an alternative procedure performed by interventional radiologists that allows decompression of portal hypertension. In many cases, ascites is improved after TIPS, but long-term randomized trials for tense or refractory ascites comparing TIPS with standard therapy are not conclusive. Liver transplantation is the ultimate step for the treatment of ascites, providing the cure for the underlying liver disease as well. Transplantation is indicated when quality of life of the patient is impaired due to recurrent episodes of ascites, or in the presence of spontaneous bacterial peritonitis and hepatorenal syndrome.

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Ascites reinfusion using the Rhodiascit apparatus—clinical experience and coagulation abnormalities

Cited by 27 publications

References 1 publication

Management of Renal Complications of Liver Disease

Management of Renal Complications of Liver Disease

Pathogenesis, Diagnosis and Treatment of Ascites in Cirrhosis

Treatment of Ascites: Old and New Remedies

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