CLINICAL CASE 41: ANSWERS and SUMMARY

What is the best known successful treatment for Dialysis Associated Ascites?

Intense Hemodialysis	10 (17%)
Intense Ultrafiltration	9 (15%)
Kidney Transplantation	21 (36%)
Angiotensin Converting Enzyme Inibitors	0 (0%)
Repeated Paracentesis	4 (6%)
Albumin infusion with ultrafiltration	14 (24%)

Dialysis associated ascites is a rare phenomenon these days.  Usually happens 8-69 months on dialysis and most cases are of patients with Glomerular diseases or HTN. We don't see it that much these days as more efficient dialysis happens and causes of ESRD are non glomerular diseases.  Many pathologic mechanisms have been proposed. A recent review by myself on this topic sheds light into the this entity.


In terms of treatment:- All mentioned above modalities have been tried and can work but the most definitive treatment is kidney transplantation( as most of you picked).  Complete resolution of ascites with long term improvement in quality of life has been reported in 21 of 28 patients that were studied post transplant.

See below:
Ref:
http://www.ncbi.nlm.nih.gov/pubmed/21801212
http://www.ncbi.nlm.nih.gov/pubmed/9715728