Outcome of peritoneal dialysis in cirrhotic patients with chronic renal failure

Vecchi, Amedeo F. De; Colucci, Patrizia; Salerno, Francesco; Scalamogna, Antonio; Ponticelli, Claudio

doi:10.1053/ajkd.2002.33925

Cited by 49 publications

(79 citation statements)

References 17 publications

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“…Nach 1990 haben acht Publikationen [6][7][8][9][10][11][12][13] von insgesamt etwa 60 Patienten mit Lebererkrankungen und Aszites berichtet, die mit PD über Zeiträume von bis zu 8 Jahren behandelt wurden. Akute hypotone Zwischenfälle an der PD werden in diesen Studien nicht berichtet.…”

Section: Hämodynamische Toleranz Bei Dialysepatienten Mit Lebererkranunclassified

“…Auch bei Patienten, die wegen intradialytischen Blutdruckabfäl-len von der HD an die PD transferiert wurden, war die hämodynamische Toleranz sehr gut [8][9]. In der Arbeit von De Vecchi et al [13] wurden die klinischen Ergebnisse von 21 PD-Patienten mit Leberzirrhose und 41 PDPatienten ohne Lebererkrankung verglichen. Eine chronische Hypotonie fand sich in dieser Studie bei 24% der PD-Patienten mit Leberzirrhose, aber nur 5% der Kontrollpatienten.…”

Section: Hämodynamische Toleranz Bei Dialysepatienten Mit Lebererkranunclassified

“…Eine chronische Hypotonie fand sich in dieser Studie bei 24% der PD-Patienten mit Leberzirrhose, aber nur 5% der Kontrollpatienten. Umgekehrt traten akute hypotensive Episoden oder auch hypertensive Blutdruckwerte ausschließlich in der Kontrollgruppe ohne Lebererkrankung auf [13].…”

Section: Hämodynamische Toleranz Bei Dialysepatienten Mit Lebererkranunclassified

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Peritonealdialyse bei Patienten mit Leberzirrhose und/oder Aszites

Paul

2005

Wien Klin Wochenschr

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In older textbooks the use of peritoneal dialysis (PD) in patients with liver cirrhosis and/or ascites was contraindicated. Only a small number of papers have focused on this problem and they mainly consist of case reports and retrospective studies of small numbers of patients. In addition, most nephrologists' experience of performing PD in patients with liver diseases is rather limited. Nevertheless, for these patients PD offers a wide range of advantages, such as a simplified ascites management, since repeated abdominal punctures become unnecessary. Furthermore, because of continuous peritoneal ultrafiltration, hemodynamic tolerance during PD is significantly better than in hemodialysis and results in a markedly lower frequency of hypotensive episodes. The risk of nosocomial infection with hepatitis B or C viruses can also be reduced by treating these patients with home PD. Although some authors suggest that PD patients with liver cirrhosis have an especially increased risk of Gram-negative peritonitis, currently available data show controversial results. There is also little information in the literature on the impact of increased peritoneal protein loss on malnutrition and outcome of these patients. Nevertheless, recent studies have shown that protein loss into the peritoneal cavity in PD patients with liver cirrhosis is high only initially, stabilizing at a lower level in the further course of treatment. In conclusion, in patients with end-stage renal disease suffering from liver cirrhosis and/or ascites, PD can be considered as a good or adequate treatment option.

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Section: Hämodynamische Toleranz Bei Dialysepatienten Mit Lebererkranunclassified

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Peritonealdialyse bei Patienten mit Leberzirrhose und/oder Aszites

Paul

2005

Wien Klin Wochenschr

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“…Unfortunately, most studies do not provide sufficient information to prove this theory. The peritonitis rate in the study by De Vecchi et al [2] was lower in PD patients with liver cirrhosis than in control PD patients (0.31 episodes/year vs 0.53 episodes/year, n.s.). In the group with hepatic disease Gram-positive bacteria were the causative organisms in two thirds of cases.…”

Section: Authors' Replymentioning

confidence: 70%

“…Perhaps I can shed some light on the underlying mechanism for such conflicting data. Over a quarter of a century ago we had investigated the immune mechanisms for the susceptibility of patients with liver disease to spontaneous E. coli peritonitis [2]. We found that in severe liver disease complement production is decreased along with albumin.…”

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confidence: 99%