Ultrafiltration by hemofilter--a new therapeutic measure in intractable ascites

The clinical efficacy of ultrafiltration (UF) of ascitic fluid with hemofilter in the treatment of intractable ascites associated with chronic liver disease or intraabdominal malignancy was studied in fifteen patients. The ascitic fluid was reinfused into the peritoneal cavity after ultrafiltration. An average of 6.2 liters of fluid was removed during 4.4 hours of ultrafiltration with no significant change in blood pressure, central venous pressure, hemoglobin, platelets or plasma creatinine. Ascitic fluid albumin rose significantly immediately after the procedure (from 5.2 +/- 4.3 gm/L to 31.9 +/- 30.0 gm/L, P less than 0.01). The plasma albumin concentration increased significantly at the end of UF (P less than 0.001). Also there was a significant increase in urine output (P less than 0.001), urinary sodium excretion (P less than 0.001), and endogenous creatinine clearance (P less than 0.01) during the 48 hours following UF. There was no evidence of hemodynamic, renal or hematological dysfunction, and other complications, including encephalopathy, peritonitis and variceal bleeding were not experienced. Ultrafiltration of ascitic fluid with hemofilter may be safely used in the temporary relief of refractory ascites due to cirrhosis or intra-abdominal malignancy.