Letter: long‐term abdominal drains in refractory ascites—evolving concept of palliative care in decompensated cirrhosis

Roy, Akash; Taneja, Sunil; Duseja, Ajay; Singh, Virendra

doi:10.1111/apt.15944

Cited by 3 publications

(1 citation statement)

References 4 publications

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“…Some patients have reported a preference for LTAD as it avoids repeat LVPs in hospital, allows for personalised care, improved symptom control of ascites, and regular support from community nurses 85 . However, bacterial peritonitis, ascites leakage, and local cellulitis remain concerns 86 . There is currently a large palliative interventional trial underway in the United Kingdom to assess whether LTADs result in better health related quality of life compared with LVP in patients with end‐stage liver disease with RA (REDUCe 2).…”

Section: New Concepts In Ascites Managementmentioning

confidence: 99%

Review article: Recent advances in ascites and acute kidney injury management in cirrhosis

Adebayo,

Wong

2024

Aliment Pharmacol Ther

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SummaryBackgroundBetter understanding of disease pathophysiology has led to advances in managing ascites and its associated complications including hepatorenal syndrome‐acute kidney Injury (HRS‐AKI), especially medicinal and interventional advances.AimTo review the latest changes in the management of ascites and HRS‐AKI.MethodsA literature search was conducted in Pubmed, using the keywords cirrhosis, ascites, renal dysfunction, acute kidney injury, hepatorenal syndrome, beta‐blockers, albumin, TIPS and vasoconstrictors, including only publications in English.ResultsThe medicinal advances include earlier treatment of clinically significant portal hypertension to delay the onset of ascites and the use of human albumin solution to attenuate systemic inflammation thus improving the haemodynamic changes associated with cirrhosis. Furthermore, new classes of drugs such as sodium glucose co‐transporter 2 are being investigated for use in patients with cirrhosis and ascites. For HRS‐AKI management, newer pharmacological agents such as vasopressin partial agonists and relaxin are being studied. Interventional advances include the refinement of TIPS technique and patient selection to improve outcomes in patients with refractory ascites. The development of the alfa pump system and the study of outcomes associated with the use of long‐term palliative abdominal drain will also serve to improve the quality of life in patients with refractory ascites.ConclusionsNew treatment strategies emerged from better understanding of the pathophysiology of ascites and HRS‐AKI have shown improved prognosis in these patients. The future will see many of these approaches confirmed in large multi‐centre clinical trials with the aim to benefit the patients with ascites and HRS‐AKI.

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Section: New Concepts In Ascites Managementmentioning

confidence: 99%

Review article: Recent advances in ascites and acute kidney injury management in cirrhosis

Adebayo,

Wong

2024

Aliment Pharmacol Ther

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Letter: long‐term abdominal drains in refractory ascites—evolving concept of palliative care in decompensated cirrhosis. Authors' reply

Macken

Bremner

Sheridan

et al. 2020

Aliment Pharmacol Ther

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Management of refractory ascites

Wong

2023

Clin Mol Hepatol

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The development of refractory ascites in approximately 10% of patients with decompensated cirrhosis heralds the progression to a more advanced stage of cirrhosis. Its pathogenesis is related to significant hemodynamic changes, initiated by portal hypertension, but ultimately leading to renal hypoperfusion and avid sodium retention. Inflammation can also contribute to the pathogenesis of refractory ascites by causing portal microthrombi, perpetuating the portal hypertension. Many complications accompany the development of refractory ascites, but renal dysfunction is most common. Management starts with continuation of sodium restriction, which needs frequent reviews for adherence; and regular large volume paracentesis of 5 L or more with albumin infusions to prevent the development of paracentesisinduced circulatory dysfunction. Albumin infusions independent of paracentesis may have a role in the management of these patients. The insertion of a covered, smaller diameter, transjugular intrahepatic porto-systemic stent shunt (TIPS) in the appropriate patients with reasonable liver reserve can bring about improvement in quality of life and improved survival after ascites clearance. Devices such as an automated low-flow ascites pump may be available in the future for ascites treatment. Patients with refractory ascites should be referred for liver transplant, as their prognosis is poor. In patients with refractory ascites and concomitant chronic kidney disease of more than stage 3b, assessment should be referred for dual liver-kidney transplants. In patients with very advanced cirrhosis not suitable for any definitive treatment for ascites control, palliative care should be involved to improve the quality of life of these patients. Clin Mol Hepatol 2022 Jun 9.

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Letter: long‐term abdominal drains in refractory ascites—evolving concept of palliative care in decompensated cirrhosis

Abstract: LINKED CONTENTThis article is linked to Macken et al papers. To view these articles, visit https://doi.org/10.1111/apt.15802 and https://doi.org/10.1111/apt.15983

Cited by 3 publications

References 4 publications

Review article: Recent advances in ascites and acute kidney injury management in cirrhosis

Review article: Recent advances in ascites and acute kidney injury management in cirrhosis

Letter: long‐term abdominal drains in refractory ascites—evolving concept of palliative care in decompensated cirrhosis. Authors' reply

Management of refractory ascites

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