Clinical outcomes of peritoneal dialysis in patients with chronic liver and kidney failure: A single-center study

Simultaneous liver-kidney (SLK) transplant is the ideal therapeutic option for patients with chronic liver and kidney failure (CLKF), but the shortage of organs leaves many patients dialysis dependent. Hemodialysis is frequently utilized but is poorly tolerated due to exacerbation of preexisting intravascular instability. Peritoneal Dialysis (PD) may pose several advantages: providing hemodynamic stability, and ascites management.

This was a retrospective observational study that included all patients with CLKF who initiated PD from July 2002 to December 2022 at the University of Texas Southwestern Medical Center/DaVita Dialysis Center. Medical charts were reviewed for demographics, clinical outcomes, laboratory values, and censoring events.

27 patients with CLKF initiated PD during this period. The mean MELD-3.0 score was 25. A total of 23 patients had clinical ascites requiring frequent large-volume paracentesis prior to PD initiation. Mean follow-up was 42.4 + 39 months. Peritonitis rates were 0.21 episodes per patient-year on PD. Six patients died with an annualized mortality of 63/1,000 patient-years. The hospitalization rate was 0.82 per patient-year. Six patients received an SLK transplant, and 1 received liver transplant followed by a kidney transplant. Six patients remained on the waiting list, and 2 were in the transplant work-up by the study end. Ten patients were deemed ineligible for SLK transplant. It is noteworthy that none of these patients required large-volume paracentesis after PD initiation.

In this single-center study on PD patients with CLKF, we observed excellent outcomes, with mortality, hospitalizations, and peritonitis rates comparable to those of the general PD population. Furthermore, by providing continuous drainage of ascites, PD alleviated the need for large-volume paracentesis. In addition, PD did not affect the candidacy for SLK transplant. Hence, PD should be considered a viable dialysis modality in patients with CLKF.