Combination of hemodialysis and ascites dialysis as an effective management for a renal failure patient with refractory ascites caused by decompensated liver cirrhosis: a case report

We describe the effect of combined therapy of hemodialysis and ascites dialysis in a chronic renal failure patient with liver cirrhosis and refractory ascites. The patient was a 77-year-old woman who had been diagnosed as liver cirrhosis due to hepatitis C hepatitis 10 years ago. She had been diagnosed with chronic renal failure one year ago and received conservative treatment. She was admitted to our hospital to start hemodialysis because uremic symptoms and severe anemia were observed. An arterio-venous fistula was constructed utilizing the left radial artery and left cephalic vein, and an Abdominal Port (SMAP-27; Nipro) was implanted simultaneously in the subcutaneous tissue, inserting a catheter through the abdominal cavity into Douglas' cul-de-sac. A twenty-gauge needle was injected into the port and removed ascites by an extra pump during hemodialysis. Ascites, after condensed and dialyzed by another hemopump, was re-infused into the arterial chamber side of the blood circuit. Hemodialysis continued for 30 to 60 minutes. As a result, serum total protein level rose from 4.6g/dL to 6.0g/dL. After starting treatment, she because able to take an adequate meal because the sense of full stomach disappeared, and her daily activity improved. No notable side effect was found and systemic hemodynamics remained stable. It is suggested that ascites dialysis facilitates removal of hepatic and renal toxins from ascites by ultrafiltrating and dialyzing, and controls water balance and body weight without causing hypotensive episodes. Compared to classical paracentesis, SMAP-27 is found to be a useful and safe device because it is easily punctured into abdominal cavity. Her symptoms by ascites was reduced, thus, enhancing the patients' activity and quality of life.