Effect of Liver Cirrhosis on the Outcomes of Peritoneal Dialysis

Jung, Young Lee; Park, Sun-Hee; Lee, Chung Sik; Lim, Chun Soo; Kim, Yon Su; Oh, Kook Hwan; Han, Seung Seok

doi:10.3747/pdi.2018.00247

Cited by 4 publications

(2 citation statements)

References 25 publications

(33 reference statements)

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“…We do not use (SBP) prophylaxis prior to PD catheter placement although studies have not specifically looked at this population. Peritonitis rates have not been found to be increased in the patients with ascites treated with PD 24 . Peritonitis in PD will be discussed separately below.…”

Section: Cirrhosismentioning

confidence: 99%

“…As discussed above, PD has advantages in cirrhotic patients with ascites and hypotension, but the downside is a risk of worsening hypoalbuminemia. Studies show that compared to patients on PD without cirrhosis, there are no increases in risk of technique failure, peritonitis rates, or mortality when doing PD in a patient with cirrhosis 24,26 …”

Section: Cirrhosismentioning

confidence: 99%

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When ESKD complicates disease management: GI bleeding and other GI illnesses

Salani

Golper

2020

Seminars in Dialysis

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The presentation of gastrointestinal (GI) illnesses is similar in patients with end-stage kidney disease (ESKD) and in the general population. However, there are several instances where kidney failure and renal replacement therapy (RRT) can affect the course of the disease and its management. In this section, we will focus on unique factors of GI illnesses that should be considered in the ESKD population with and without residual kidney function (RKF). We will also discuss the role of RRT modalities in the occurrence and treatment of GI disease. How to cite this article: Salani M, Golper T. When ESKD complicates disease management: GI bleeding and other GI illnesses. Semin Dial. 2020;33:263-269. https://doi.

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Section: Cirrhosismentioning

confidence: 99%

Section: Cirrhosismentioning

confidence: 99%

When ESKD complicates disease management: GI bleeding and other GI illnesses

Salani

Golper

2020

Seminars in Dialysis

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Outcomes of peritoneal dialysis in cirrhosis: A systematic review and meta-analysis

Mekraksakit,

Suppadungsuk,

Thongprayoon

et al. 2024

Perit Dial Int

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Background: Cirrhosis and end-stage kidney disease (ESKD) are significant global health concerns, contributing to high mortality and morbidity. Haemodialysis (HD) is frequently used to treat ESKD in patients with cirrhosis. However, it often presents challenges such as haemodynamic instability during dialysis sessions, leading to less than optimal outcomes. Peritoneal dialysis (PD), while less commonly used in cirrhotic patients, raises concerns about the risks of peritonitis and mortality. Our systematic review and meta-analysis aimed to assess outcomes in PD patients with cirrhosis. Methods: We executed a comprehensive search in Ovid MEDLINE, EMBASE and Cochrane databases up to 25 September 2023. The search focused on identifying studies examining mortality and other clinical outcomes in ESKD patients with cirrhosis receiving PD or HD. In addition, we sought studies comparing PD outcomes in cirrhosis patients to those without cirrhosis. Data from each study were aggregated using a random-effects model and the inverse-variance method. Results: Our meta-analysis included a total of 13 studies with 15,089 patients. Seven studies compared ESKD patients on PD with liver cirrhosis (2753 patients) against non-cirrhosis patients (9579 patients). The other six studies provided data on PD (824 patients) versus HD (1943 patients) in patients with cirrhosis and ESKD. The analysis revealed no significant difference in mortality between PD and HD in ESKD patients with cirrhosis (pooled odds ratio (OR) of 0.77; 95% confidence interval (CI), 0.53–1.14). In PD patients with cirrhosis, the pooled OR for peritonitis compared to non-cirrhosis patients was 1.10 (95% CI: 1.03–1.18). The pooled ORs for hernia and chronic hypotension in cirrhosis patients compared to non-cirrhosis controls were 2.48 (95% CI: 0.08–73.04) and 17.50 (95% CI: 1.90–161.11), respectively. The pooled OR for transitioning from PD to HD among cirrhotic patients was 1.71 (95% CI: 0.76–3.85). Mortality in cirrhosis patients on PD was comparable to non-cirrhosis controls, with a pooled OR of 1.05 (95% CI: 0.53–2.10). Conclusions: Our meta-analysis demonstrates that PD provides comparable mortality outcomes to HD in ESKD patients with cirrhosis. In addition, the presence of cirrhosis does not significantly elevate the risk of mortality among patients undergoing PD. While there is a higher incidence of chronic hypotension and a slightly increased risk of peritonitis in cirrhosis patients on PD compared to those without cirrhosis, the risks of hernia and the need to transition from PD to HD are comparable between both groups. These findings suggest PD as a viable and effective treatment option for ESKD patients with cirrhosis.

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Peritoneal Dialysis Care for People with Diabetes, Polycystic Kidney Disease, or Advanced Liver Disease

Agarwal,

Gillis,

Wilkie

2024

CJASN

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People treated with peritoneal dialysis (PD) often have complicating conditions that require careful management. Three such conditions are reviewed in this article – diabetes mellitus, polycystic kidney disease (PKD) and chronic liver disease. Each of these conditions requires an understanding of both its impact on the delivery of the PD, as well as the impact of the PD on the condition itself. With respect to diabetes, glucose absorption from the dialysate complicates metabolic control, impacts on salt and water management and on patient outcome. There is particular benefit in clinical care being delivered through a multidisciplinary team that involves both kidney and diabetes experts. In relation to PKD, a key issue is the potential for increased intraperitoneal pressure due to the combined effect of the enlarged polycystic organs and the presence of the dialysis solution and therefore the PD prescription requires to be managed with a particular focus on limiting that pressure. For patients with liver disease key issues include nutritional support since PD can add to protein losses already consequent on the liver disease itself. Considered approaches are required to manage ascites, reduce infection risk and the potential for hernias and leaks to develop. Mortality in this group is unfortunately high – however PD may present a better management option than hemodialysis in many cases - particularly in those where the liver disease is complicated by low blood pressure, clotting abnormalities or troublesome ascites. Overall, the choice to use PD in patients with these complicating conditions should be based on shared decision making with the patient and their family members informed by high quality information in which risks, benefits and management strategies are clearly presented.

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Effect of Liver Cirrhosis on the Outcomes of Peritoneal Dialysis

Cited by 4 publications

References 25 publications

When ESKD complicates disease management: GI bleeding and other GI illnesses

When ESKD complicates disease management: GI bleeding and other GI illnesses

Outcomes of peritoneal dialysis in cirrhosis: A systematic review and meta-analysis

Peritoneal Dialysis Care for People with Diabetes, Polycystic Kidney Disease, or Advanced Liver Disease

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