Husain-Syed F, Muciño-Bermejo María-Jimena, Ronco C, Seeger W, Birk Horst-Walter

Language: English
References: 16
Page: 929-932
PDF size: 104.75 Kb.

ABSTRACT

Pulmonary hypertension is a common finding in patients with advanced liver disease. Similarly, among patients with advanced pulmonary arterial hypertension, right heart failure leads to congestive hepatopathy. Diuretic resistant fluid overload in both advanced pulmonary hypertension and chronic liver disease is a demanding challenge for physicians. Venous congestion and ascites-induced increased intra-abdominal pressure are essential regarding recurrent hospitalization, morbidity and mortality. Due to impaired rightventricular function, many patients cannot tolerate extracorporeal ultrafiltration. Peritoneal dialysis, a well-established, hemodynamically tolerated treatment for outpatients may be a good alternative to control fluid status. We present a patient with pulmonary arterial hypertension and congestive hepatopathy hospitalized for over 3 months due to ascites induced refractory volume overload treated with peritoneal ultrafiltration. We report the treatment benefits on fluid balance, cardiorenal and pulmonary function, as well as its safety. In conclusion, we report a case in which peritoneal ultrafiltration was an efficient treatment option for refractory ascites in patients with congestive hepatopathy.

REFERENCES

1. Damman K, van Deursen VM, Navis G, Voors AA, van Veldhuisen DJ, Hillege HL. Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. J Am Coll Cardiol 2009; 53: 582-8.

2. Mullens W, Abrahams Z, Francis GS, Sokos G, Taylor DO, Starling RC, Young JB, et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol 2009; 53: 589-96.

3. Mucino-Bermejo J, Carrillo-Esper R, Uribe M, Mendez- Sanchez N. Acute kidney injury in critically ill cirrhotic patients: a review. Ann Hepatol 2012; 11: 301-10.

4. Barbano B, Sardo L, Gigante A, Gasperini ML, Liberatori M, Giraldi GD, Lacanna A, et al. Pathophysiology, diagnosis and clinical management of hepatorenal syndrome: from classic to new drugs. Curr Vasc Pharmacol 2014; 12: 125-35.

5. Karcz M, Bankey B, Schwaiberger D, Lachmann B, Papadakos PJ. Acute respiratory failure complicating advanced liver disease. Semin Respir Crit Care Med 2012; 33: 96-110.

6. Halank M, Strassburg CP, Hoeper MM. Pulmonary complications of liver cirrhosis: hepatopulmonary syndrome, portopulmonary hypertension and hepatic hydrothorax. Der Internist 2010; 51: 255-63.

7. Uribe M, Morales-Blanhir J, Rosas-Romero R, Campos Cerda R, Poo JL. Epidemiology, physiopathology and diagnosis of pulmonary hypertension in hepatic (PH) cirrhosis. Gac Med Mex 2012; 148: 153-61.

8. Van der Linden P, Le Moine O, Ghysels M, Ortinez M, Deviere J. Pulmonary hypertension after transjugular intrahepatic portosystemic shunt: effects on right ventricular function. Hepatology 1996; 23: 982-7.

9. Modock J. Acute pulmonary hypertension after transjugular intrahepatic portosystemic shunt: a potentially deadly but commonly forgotten complication. Gastroenterol Nurs 2014; 37: 33-8; quiz 9-40.

10. Bertoli SV, Musetti C, Ciurlino D, Basile C, Galli E, Gambaro G, Iadarola G, et al. Peritoneal ultrafiltration in refractory heart failure: a cohort study. Perit Dial Int 2014; 34: 64-70.

11. Udani SM, Murray PT. The use of renal replacement therapy in acute decompensated heart failure. Semin Dial 2009; 22: 173-9.

12. Grace BS, Clayton PA, Gray NA, McDonald SP. Socioeconomic differences in the uptake of home dialysis. CJASN 2014; 9: 929-35.

13. Coentrao LA, Araujo CS, Ribeiro CA, Dias CC, Pestana MJ. Cost analysis of hemodialysis and peritoneal dialysis access in incident dialysis patients. Perit Dial Int 2013; 33: 662-70.

14. De Vecchi AF, Colucci P, Salerno F, Scalamogna A, Ponticelli C. Outcome of peritoneal dialysis in cirrhotic patients with chronic renal failure. Am J Kidney Dis 2002; 40: 161-8.

15. Marcus RG, Messana J, Swartz R. Peritoneal dialysis in end-stage renal disease patients with preexisting chronic liver disease and ascites. Am J Med 1992; 93: 35-40.

16. Chaudhary K, Khanna R. Renal replacement therapy in endstage renal disease patients with chronic liver disease and ascites: role of peritoneal dialysis. Perit Dial Int 2008; 28: 113-7.