Peritoneal Dialysis Catheters for the Treatment of Refractory Ascites

Abstract

Liver Cirrhosis, remains an incurable disease with many complications including ascites. Ascites develops in most patients and has been associated with higher mortality, poor quality of life (QOL), risk of infections, and renal failure. A small subgroup of patients become refractory to mainstay therapy with sodium restriction and diuretics. In these patients, management includes serial large volume paracentesis (LVP), trans-jugular intra-hepatic porto-systemic shunts (TIPS), liver transplant, or surgical placement of a peritonovenous shunt. The other options are scarce or pose higher risk of severe complications, such as encephalopathy, and poor health related QOL. An alternative for management is the bedside placement of an Argyle peritoneal dialysis (PD) catheter. Potential advantages include: ability to drain fluid at home, increased frequency of drainage, and fewer complications. The goal of this study was to evaluate health related QOL via the physical component score (PCS) of the Short-Form-36 in patients with refractory ascites by conducting a randomized controlled trial comparing PD catheters to LVP. Over 1 year, 2 patients completed the study of 20 that were eligible from 2302 screened charts. The study was ultimately non-feasible at our center due to insufficient enrollment. The main reasons included physician and patient reluctance in participating in an RCT, misconceptions about the safety of the procedure, and a small population size. A nationwide survey is planned to examine whether equipoise exists for this procedure to determine how to proceed with the study question.