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KMID : 0882419960510020187
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Korean Journal of Medicine
1996 Volume.51 No. 2 p.187 ~ p.193
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CAPD in End-Stage Renal Disease Patients with Preexisting Lver Cirrhosis
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Abstract
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Objectives:
@EN The spontaneous tendency to arterial hypotension in cirrhotic patients makes adequate hemodialysis therapy extremely difficult, Hemodialysis in these patients may produce intradialytic hypotension, limiting the amount of ultrafiltration.
These
patients are also at high risk for gastrointestinal bleeding, which can be exacerbated by anticoagulation. Recently peritoneal dialysis has been suggested for the management of this population.
@ES Methods:
@EN Seven patients with chronic renal failure and liver cirrhosis treated by CAPD are described. Six of the seven patients were complicated by ascites on starting CAPD. Hepatocellular carcinoma was identified in one patients. Three had been
transferred
from hemodialysis for hemodynamic intolerance, one for vascular access problem. All PD catheters were surgically placed.
@ES Results:
@EN The hemodynamic tolerance was excellent in all patients. Four patients developed bleeding immediately after catheter insertion. Two patients developed early leaks and one patients late leak. Four patients had a decline in serum albumin level
of
0.5gm/dL or more during the course of chronic PD. Peritonitis occurred on average at 8.7 month interval. Three episodes of catheter removal occurred in 148 patient-months of PD(0.24 per patients-year). Four patients died while maintained on PD;
three
deaths were due to hepatic encephalopathy on PD for duration of 4 to 60 months and the fourth was due to peritonitis after 24 months of PD. One patient died due to malnutrition after 2 months on switching to hemodialysis because of peritonitis
after 32
months of PD.
@ES Conclusion:
@EN Early mechanical complications after catheter insertion(bleeding, leak) were more common than usual. But CAPD was better tolerable than hemodialysis and may be a reasonable choice with an acceptable survival rate in end-stage renal disease
patients
with preexisting liver cirrhosis.
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KEYWORD
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