Peritonealdialyse bei Patienten mit Leberzirrhose und/oder Aszites

Abstract

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.

Peritoneal dialysis in patients with liver cirrhosis and/or ascites

“…We want to thank Prof. Diskin for his interesting and important comment on possible reasons for differences in the type of peritoneal dialysis (PD)-associated peritonitis in several populations of cirrhotic patients, as cited in the Letter to the Editor article by G. Paul [1]. His hypothesis on the association between stage of hepatic disease, complement activity in ascites and incidence of Gram-negative peritonitis is in agreement with our clinical experience.…”

“…I would like to extend my congratulations to Dr. Paul for his recent excellent review of peritoneal dialysis (PD) in patients with ascites and cirrhosis [1]. As Dr Paul notes while one might expect an increased incidence of gram negative peritonitis in PD patients with liver disease, the clinical reports are conflicting.…”