Management of refractory ascites using nocturnal home hemodialysis

Ascites in patients with end-stage renal disease (ESRD) poses a challenging management scenario for nephrologists. We present two patients with ascites refractory to treatment with standard outpatient hemodialysis which resolved upon the initiation of nocturnal home hemodialysis (NHD). NHD is a form of intensive renal replacement therapy whereby patients receive up to 8 hours of continuous hemodialysis and ultrafiltration, five to seven times per week. In both cases, the ascites resolved within weeks of changing hemodialysis modalities. NHD allowed a significant reduction in ultrafiltration rates, which likely underlies the procedural tolerability and contributed to the successful outcomes. This option could be considered in the management of the patient with ESRD and refractory ascites.