Strict volume control in the treatment of nephrogenic ascites

Nephrogenic ascites refers to the condition of refractory ascites of unknown aetiology and occurs mainly in patients with end-stage renal disease who are undergoing haemodialysis. Despite many treatment modalities, nephrogenic ascites remains difficult to control and has a poor prognosis.

We investigated six such patients who had developed severe, apparently refractory ascites during haemodialysis. They all had seriously disturbed cardiac dimensions and function. They were treated with repeated isolated ultrafiltration and severe salt restriction, while their cardiac functions were monitored with echocardiography.

After a mean of 18+/-4 l of fluid per patient was removed in 27+/-8 days, ascites disappeared in all patients. Blood pressure and cardiothoracic indices were decreased from 130+/-20/83+/-10 to 95+/-11/60+/-6 mmHg (P<0.02) and from 0.61+/-7 to 0.47+/-5 (P<0.02), respectively. At the end of treatment, heart rates had decreased from 102+/-10 to 85+/-6 beats/min. Previously increased left atrial diameters, end-systolic and end-diastolic dimensions of the left ventricles, and right ventricular diameters reached normal values. Ejection fractions initially decreased in all patients, and then increased slightly to markedly after treatment.

Nephrogenic ascites is a component of right-sided cardiac congestion mediated by volume overload, and it should be treated with severe salt restriction and frequent ultrafiltration with haemodialysis and, if that fails, with daily isolated ultrafiltration.