CAPD for treatment of ESRD patients with ascites secondary to liver cirrhosis

The treatment of cirrhotic patients with ascites and end-stage renal disease (ESRD) is complex. Continuous ambulatory peritoneal dialysis (CAPD), as a continuous therapy, represents an alternative to hemodialysis-associated hemodynamic intolerance. We report our experience with 5 cirrhotic patients with ascites who were treated by CAPD. Three had been transferred from hemodialysis (HD) for intolerance. The hemodynamic tolerance was excellent in all patients, and solute and water peritoneal transport were increased over the normal range in all cases. Morbidity was principally related to liver disease. Peritoneal protein losses, initially high, decreased over time. Serum albumin was within the low normal range. The incidence of peritonitis was higher than usual in these patients; episodes caused by gram-negative bacteria, streptococci and listeria, were predominant. The cause of death was not CAPD-related. In our experience, CAPD should be the treatment of choice for cirrhotic patients with ascites who require dialysis.