Renal Replacement Therapy in End-Stage Renal Disease Patients with Chronic Liver Disease and Ascites: Role of Peritoneal Dialysis

Chronic liver disease and cirrhosis account for several thousand deaths in the United States and often these patients have renal disease that progresses to end-stage renal disease (ESRD), necessitating renal replacement therapy. These patients provide significant challenges to their physicians, especially in the management of their ESRD with dialysis. ESRD patients with chronic liver disease and ascites are more difficult to manage on hemodialysis (HD) due to their hemodynamic status and risk of bleeding. Peritoneal dialysis (PD) offers them a viable alternative, along with a stable hemodynamic status and a lower risk of bleeding. The overall morbidity and mortality as well as the risk of peritonitis appear to be almost similar between cirrhotic and non-cirrhotic PD patients. In the absence of clinical trials comparing HD versus PD in such a population, and despite the limited clinical observations, the authors support PD as a viable and effective form of renal replacement therapy for patients with ESRD and associated chronic liver disease with cirrhosis and ascites.

Peritoneal dialysis for the removal of protein-bound markers of hepatic insufficiency

The addition of human serum albumin (HSA) to peritoneal dialysate increases the clearance of bilirubin in rats suffering from obstructive jaundice. The acceptor properties of the fluid can be enhanced by using HSA that does not contain standard stabilizing additives and has been purified by further adsorption on activated carbon. Bilirubin-containing dialysate fluid, as well as the ascitic fluid of cirrhotic patients, can be regenerated by a combination of membrane ultrafiltration and carbon adsorption. These observations suggest a potentially useful scheme for continuous, regenerative peritoneal dialysis in the treatment of hepatic insufficiency.