Local steroid therapy of refractory ascites associated with dialysis

Ascites and Kidney Transplantation: Case Report and Critical Appraisal of the Literature

“…The results of bilateral nephrectomy as a treatment for NA have been inconsistent [1,18,19]. Other treatment options for NA include maintenance or continuous ambulatory peritoneal dialysis [13], placement of either a Denver or a LeVeen shunt [20,21], extracorporeal ultrafiltration of the ascitic fluid [22], and autologous reinfusion of the ultrafiltered ascitic fluid [23], as well as peritoneal instillation of steroids in rare cases [24]. The overall results with each of these modalities, however, have been unsatisfactory.…”

What should be done to treat dialysis‐associated ascites?

“…Because peritoneal hemosiderosis has been implicated as a cause of this entity, desferrioxamine therapy along with phlebotomy has improved ascites in some cases (4). Intraperitoneal administration of steroids and parathyroidectomy has proved successful in some cases (13,14). Table 1 summarizes medical and surgical therapies attempted in this entity.…”

Ascites in Chronic Hemodialysis: A Review

“…Intraperitoneal steroid instillation has its rationale in its partial efficacy in the treatment of uremic pericarditis and effusion (69). Its use in ascites has been disappointing (70)(71)(72)(73). Bilateral nephrectomy was originally suggested as the treatment of choice in 1974 for a select group of chronic hemodialysis patients with a syndrome manifested by ascites, wast-ing and cachexia, plus intractable hypertension (40).…”